PPI MEDIC SSN_Final.pdf

Centers for Medicare & Medicaid Services (CMS) Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC)

Sources Sought Notice (SSN) 260656J

THIS IS NOT A REQUEST FOR PROPOSAL (RFP) or SOLICITATION AND DOES

NOT COMMIT CMS TO AWARD A CONTRACT NOW OR IN THE FUTURE.

Purpose:

This Sources Sought Notice is being issued to determine the availability and capability of potential small businesses (SBs) (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business and woman-owned small business) to support the Centers for Medicare & Medicaid Services (CMS), and specifically the Center for Program Integrity (CPI), in its Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC) work focused on conducting fraud, waste, and abuse (FWA) detection, deterrence, and prevention activities for Medicare Parts C and D by focusing primarily on data analyses, audits and reviews of Medicare Advantage Organizations (MAOs) (including Medicare Advantage Prescription Drug (MA-PD) plans) and stand-alone Prescription Drug Plan Sponsors (PDPs), outreach and education, and referrals to law enforcement and other appropriate entities. The desired outcomes of these efforts are to work collaboratively with MAOs, MA-PDs, and PDPs through outreach and education, to reduce FWA, and conduct audits of MAOs, MA-PDs and stand-alone PDPs thoroughly and in a timely manner and take immediate action to ensure that the Medicare Trust Fund is protected.

Contractors must be registered in the System for Award Management (SAM) database located at https://www.sam.gov/SAM/ prior to award, during performance, and through final payment of any contract. Contractors may obtain information on SAM registration by visiting:

https://www.acquisition.gov.

This announcement is a Sources Sought Notice (SSN) for planning purposes only and CMS is only reviewing responses to this notice from eligible SBs under the NAICS code below.

This is not an invitation for bid, request for quote, or other solicitation and in no way obligates the Government to award a contract. CMS will not entertain questions regarding this market research.

ProgramHistory:

CMS has traditionally used the PPI MEDIC for Medicare Parts C and D plan oversight, including audits, outreach and education, and data analysis.

In January 2025, CMS contemplated separating the Part C and Part D functions of the traditional PPI MEDIC, releasing two separate Sources Sought Notifications (SSNs), the Medicare Drug Integrity Contractor (MEDIC) (250474J), which would focus on Part D audits, outreach and education, and data analysis, and the Part C Program Integrity Contractor (CPIC) (250475J), which would focus on Part C audits, outreach and education, and data analysis. Since this time CMS has reevaluated their approach and determined that the traditional version of the PPI MEDIC better aligns with the needs of the Agency. Therefore, SSNs 250474J and 250475J are https://www.acquisition.gov/ no longer relevant in terms of market research to support the procurement decisions related to the PPI MEDIC requirement.

The PPI MEDIC will continue to serve as the national contractor responsible for providing oversight of the Medicare Part C and Part D programs through supporting CMS’s strategy in maintaining and strengthening program integrity by monitoring and addressing program vulnerabilities, risks and ensuring plan sponsors’ adherence to regulatory requirements.

Instructions for Responding:

To respond to this notice, contractors must be able to indicate experience and/or the ability to provide all of the numbered points below. Please reference the Draft Statement of Work (SOW) for definitions and clarification of terms. Responses based upon anticipated teaming arrangements and Joint Ventures are acceptable. The capability of each team member (prime contractor and subcontractors) shall be demonstrated relative to the anticipated functions/roles to be performed by each. Contractors must give enough detail so the response clearly indicates knowledge and experience with the Draft SOW requirements, including:

1. Knowledge of and experience with conducting analysis of Medicare Parts C and D data.

2. Knowledge of and experience with conducting analysis of healthcare data for the purpose of detecting Fraud, Waste and Abuse.

3. Experience conducting audits of Medicare Advantage Organizations (MAOs), Medicare

Advantage Prescription Drug (MA-PD) plans and stand-alone Prescription Drug Plan Sponsors (PDPs). In the absence of experience with audits of MAOs, MA-PDs and stand-alone PDPs, list experience with healthcare related audits.

4. Experience developing presentations and materials for the purpose of promoting outreach, education, and collaboration with stakeholders, such as Law Enforcement and plan sponsors.

5. Experience with identifying vulnerabilities in healthcare programs, such as Medicare Parts C and D.

6. Knowledge of and experience with the Medicare Part C Risk Adjustment program.

7. Knowledge of and experience with using the Integrated Data Repository (IDR) for

Medicare Parts C and D data analysis. (https://www.cms.gov/about-cms/information-systems/idr)

Interested SBs having the capabilities necessary to perform the stated requirements may submit capability statements to the point of contact listed at the end of this document. CMS will take all information received into consideration when finalizing the strategy for procuring services for the PPI MEDIC. This is anticipated to be a Cost-Plus-Fixed-Fee term type contract.

CAPABILITY STATEMENTS MUST DEMONSTRATE THE REQUIREMENTS

OUTLINED ABOVE. Please address each capability in the order listed above, as applicable, and include the associated number and title.

https://www.cms.gov/about-cms/information-systems/idr

Respondents shall also submit the following business information in their response:

1. Unique Entity Identifier Number

2. Company Name

3. Company Address

4. Company Point of Contact, phone number and email address

5. Type of company under NAICS 541990 All Other Professional Services; Size

Standard $19.5 million as validated via the System for Award Management (SAM).

Additional information on NAICS codes can be found at www.sba.gov.

6. Corporate structure (e.g. corporation, LLC, sole proprietorship, partnership, limited liability partnership, professional corporation, etc.).

7. Current contracting vehicles (e.g. GSA, BPAs, IDIQ etc.) that the company is a part of the is applicable and relevant to this SSN. Point of Contact, phone number and email addresses of at least two individuals who can verify the demonstrated capabilities identified in the responses.

Teaming Arrangements: All teaming arrangements shall also include the above-cited information and certifications for each entity on the proposed team. Specifically, the capability statement must address how much effort would be performed by any proposed team member. Note that any resulting small business set aside would require that at least 50% of the cost of contract performance for personnel be expended for employees of the concern and other similarly situated subcontractor (see FAR 52.219-14, Limitations on Subcontracting).

Submission Requirements:

All capability statements shall be submitted via email to the point of contact listed below. The title of the email shall read “SBs Response to PPI MEDIC SSN 260656J” Responses must be submitted no later than 1:00 PM, local time, Baltimore, MD, November 24, 2025. Responses shall be limited to 10 single-sided pages. Pages should be single-spaced, 12 point font with a minimum of one inch margins on all sides.

Responses should be sent electronically to Charlene Barnes, Contract Specialist, at charlene.barnes1@cms.hhs.gov with a courtesy copy to Jennifer Kuhn, Contracting Officer, at jennifer.kuhn@cms.hhs.gov.

Disclaimer and Important Notes:

This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. The Government reserves the right to use information http://www.sba.gov/ mailto:Charlene.barnes@cms.hhs.gov mailto:jennifer.kuhn@cms.hhs.gov provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization’s qualifications to perform the work. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. Responses to this notice will not be considered adequate responses to a solicitation.

Confidentiality:

No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

Protection of Privileged or Confidential Commercial or Financial Information

The Freedom of Information Act (FOIA), 5 U.S.C. § 552, provides individuals with a right to access certain records in the possession of the Federal government, subject to certain exemptions. Exemption 4 of the FOIA permits information to be withheld that is in the nature of "trade secrets and commercial or financial information obtained from a person and privileged or confidential." The term "person" refers to a wide range of entities, including corporations, banks, state governments, agencies of foreign governments, and Native American tribes or nations, who provide information to the government. Information that does not qualify withholding under the Exemption will be disclosed.

CMS may invoke Executive Order 12600 in accordance with FOIA Regulation 45 C.F.R. §

5.42. Information provided by entities to CMS in response to this notice may be subject to FOIA disclosure requirements unless protected under Exemption 4 of the Freedom of Information Act. Should entities wish to protect any trade secret or confidential information under Exemption 4, they should mark their submission accordingly citing applicable redactions and non-disclosure rationale. Pre-disclosure redactions and non-disclosure rationale shall be sent via e-mail to the requesting contracting officer with a copy to the CMS FOIA Office at 12600@cms.hhs.gov.

If an entity’s submission is not marked and CMS receives a FOIA request related to this notice, the CMS Contracting Officer will notify the entity. The entity will have 10 working days to object to the release of any part of their information submitted to CMS citing relevant case law. Final determination on the applicability of Exemption 4 of the FOIA are made on a case-by-case basis by CMS.

The statutory language of the FOIA is codified at 5 U.S.C. § 552(b). Additional information and resources, including the 9 FOIA Exemptions and HHS FOIA Regulation, and examples, can be found on the HHS FOIA Website.

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