Medicare Drug Integrity Contractor (MEDIC)
Closed Pre-Solicitation Posted
- Solicitation number
- 250474J
- Agency
-
Centers for Medicare and Medicaid Services
Department of Health and Human Services
- Responses due
- Set-aside
- Total Small Business
Opportunity facts
- NAICS code
- 541990 All Other Professional, Scientific, and Technical Services
- PSC
- R499 Support- Professional: Other
- Place of performance
- Baltimore, Maryland, United States
Notice details come from SAM.gov. Updated .
About this opportunity
The Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) is seeking a Medicare Drug Integrity Contractor (MEDIC) to provide oversight of the Medicare Part D program through fraud, waste, and abuse detection and prevention activities. The contractor will be responsible for conducting comprehensive data analysis, audits, outreach, and education related to Medicare Part D plan sponsors, with the primary objective of protecting the Medicare Trust Fund. Qualified small businesses must demonstrate expertise in Medicare Part D data analysis, healthcare fraud detection, audit capabilities, and proficiency with CMS-required systems. The Sources Sought Notice indicates responses are due by January 28, 2025, and must be submitted by eligible small businesses under NAICS code 541990. Respondents will be evaluated on their ability to develop and conduct data analyses, perform timely audits, and coordinate with federal, state, and local government agencies.
The contract opportunity is specifically set aside for small businesses, including 8(a), service-disabled veteran-owned, HUBZone, small disadvantaged, veteran-owned, and woman-owned small business categories. This work was previously performed by the Plan Program Integrity Medicare Drug Integrity Contractor (PPI-MEDIC), which previously managed both Medicare Parts C and D oversight. The new contract structure will separate Part D work into this MEDIC contract, while a separate Part C Program Integrity Contractor (CPIC) will handle Part C responsibilities. While no specific award value was explicitly stated, the NAICS size standard is $19.5 million, suggesting a potentially significant contract opportunity. The anticipated contract type is Cost-Plus-Fixed-Fee, and small business teaming arrangements are permitted, though they must comply with the 50% limitation on subcontracting requirement.
Notice text
This Sources Sought Notice is being issued to determine the availability and capability of potential small businesses (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 following:
The purpose of the MEDIC is to provide oversight of the Medicare Part D program. The MEDIC shall perform FWA detection and prevention activities to proactively deter FWA in Medicare Part D. The MEDIC shall perform their responsibilities under the direction of CMS. The MEDIC shall develop and conduct data analysis and audits thoroughly and in a timely manner and take immediate action to ensure that the Medicare Trust Fund is protected. The MEDIC shall use or interact with CMS-required systems as needed in the performance of its functions. Further, the MEDIC shall coordinate its activities not only with CMS, but also with agencies at the federal, state, and local levels of government as well as other CMS partners and Contractors.
CMS has traditionally used the Plan Program Integrity Medicare Drug Integrity Contractor (PPI-MEDIC) for Medicare Part C and D plan oversight, including audits, outreach and education, and data analysis. The MEDIC will perform the Part D audits, outreach and education, and data analysis work previously performed by the PPI-MEDIC. Another contract, the Part C Program Integrity Contractor (CPIC), will perform the Part C audits, outreach and education, and data analysis work.
This announcement is a Sources Sought Notice (SSN) for planning purposes only and 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.
PLEASE SEE ATTCHMENT FOR FURTHER DETAIL
Files
| File | Type | Posted |
|---|---|---|
| MEDIC SSN_FINAL.docx | DOCX document | |
| MEDIC SOW 12.12.24_DRAFT SOW.docx | DOCX document |
Similar open opportunities
| Opportunity | Agency | Set-aside | Responses due |
|---|---|---|---|
| Request for Information - CMS' Qualified Independent Contractor (QIC) Program | Centers for Medicare and Medicaid Services | No set-aside | |
| Request for Information - Fraud Defense Contracts | Centers for Medicare and Medicaid Services | No set-aside | |
| Medicare Administrative Contractor (MAC) Jurisdiction 8 (J8) - Final Solicitation | Centers for Medicare and Medicaid Services | No set-aside |
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