Part C Program Integrity Contractor (CPIC)
Closed Pre-Solicitation Posted
- Solicitation number
- 250475J
- 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 Centers for Medicare and Medicaid Services (CMS) is seeking a Part C Program Integrity Contractor (CPIC) to provide comprehensive oversight of the Medicare Part C program through fraud, waste, and abuse (FWA) detection and prevention activities. The contractor will perform data analyses, conduct audits of Medicare Advantage Organizations (MAOs), develop outreach and education programs, and coordinate with federal, state, and local government agencies. Key contract requirements include using CMS-required systems, performing timely and thorough data analysis, and protecting the Medicare Trust Fund through proactive deterrence measures. The Sources Sought Notice is specifically targeting small businesses, including 8(a), service-disabled veteran-owned, HUBZone, small disadvantaged, veteran-owned, and woman-owned businesses. Responses to this market research are due by January 28, 2025, and will be evaluated based on the ability to meet the comprehensive program integrity oversight requirements.
This opportunity is a total small business set-aside under NAICS code 541990 (All Other Professional Services), with a size standard of $19.5 million. The contract will replace responsibilities previously managed by the Plan Program Integrity Medicare Drug Integrity Contractor (PPI-MEDIC) for Medicare Part C, while a separate Medicare Drug Integrity Contractor (MEDIC) will handle Part D responsibilities. Although a specific award value is not disclosed, the complexity and scope of work suggest a significant contract with potential for substantial funding. The contract will require extensive coordination with multiple stakeholders, including CMS staff, law enforcement agencies, and other contractors. Key personnel will need to demonstrate expertise in Medicare Part C data analysis, healthcare fraud detection, MAO audits, stakeholder education, and the Medicare Part C Risk Adjustment program.
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 CPIC is to provide oversight of the Medicare Part C program. The CPIC shall perform FWA detection and prevention activities to proactively deter FWA in Medicare Part C. The CPIC shall perform their responsibilities under the direction of CMS. The CPIC 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 CPIC shall use or interact with CMS-required systems as needed in the performance of its functions. Further, the CPIC 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 CPIC will perform the Part C audits, outreach and education, and data analysis work previously performed by the PPI-MEDIC. Another contract, the Medicare Drug Integrity Contractor (MEDIC), will perform the Part D 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 ATTACHMENT FOR FULL DETAILS
Files
| File | Type | Posted |
|---|---|---|
| CPIC SOW 12.12.24_DRAFT SOW.docx | DOCX document | |
| CPIC SSN_FINAL.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 |
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