Fraud Prevention System2 ("FPS2")

The purpose of this requirement is to acquire a second generation of the Fraud Prevention System ("FPS2") and associated operational services to support the workload of Centers for Medicare & Medicaid Services ("CMS") program integrity ("PI") contractors across the Medicare and Medicaid programs.

As required by the Small Business Jobs Act of 2010 (Public Law 111-240) mandates the use of predictive modeling and other analytic technologies to identify and prevent fraud, waste, and abuse in the Medicare FFS program. The Centers for Medicare & Medicaid Services ("CMS") developed and implemented the Fraud Prevention System to implement predictive analytics technologies to identify and prevent the payment of fraudulent claims in the Medicare Fee-for-Service Program.

The vision of the Fraud Prevention System (Version1, identified in the draft SOW as FPS1) was to establish predictive modeling tools into the claims processing system to stop payment on high risk claims. The outputs of the modeling included risk scores and proposed actions (e.g. denial, payment suspension, investigation, revocation, etc.) and appropriate data to support the actions.

CMS Center for Program Integrity ("CPI") is measured on Return on Investment ("ROI") of the FPS Program. To improve CPI's long-term ROI and align with CPI's organizational goal, FPS (Version 2, known in the DRAFT SOW as FPS2) is being undertaken to enable more efficient time-to-market for predictive models, better monitoring models and the ability to leverage more advanced modeling paradigms (such as Social Network Analysis).

By investing in FPS2 system, CMS expects a range of benefits, including cost savings in operational IT infrastructures, improved cost recovery from administrative actions, improved prevention and detection of fraud, waste, and abuse in Medicare and Medicaid program spending.