Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC)

The Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity is seeking qualified small business contractors to provide fraud, waste, and abuse (FWA) detection, deterrence, and prevention services for Medicare Parts C and D programs through the Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC) initiative. The contractor will be responsible for conducting data analyses, performing comprehensive audits of Medicare Advantage Organizations (MAOs), Medicare Advantage Prescription Drug plans (MA-PDs), and stand-alone Prescription Drug Plan Sponsors (PDPs), as well as providing outreach and education to plan sponsors while coordinating referrals to law enforcement and other appropriate entities. Key contract requirements include demonstrated expertise in Medicare data analysis, healthcare program auditing, FWA detection methodologies, stakeholder outreach, and identification of program vulnerabilities, with particular emphasis on understanding the Medicare Part C Risk Adjustment program and proficiency with the Integrated Data Repository system. Eligible small businesses include 8(a) firms, service-disabled veteran-owned small businesses, HUBZone small businesses, small disadvantaged businesses, veteran-owned small businesses, and woman-owned small businesses, with evaluation based on demonstrated capabilities across seven key areas. The capability statement submission deadline is November 24, 2025, at 1:00 PM local time, with responses limited to 10 single-sided pages.

This Sources Sought Notice does not involve a set-aside designation, and no current contractor or incumbent information is provided in the pre-solicitation materials. The anticipated contract is structured as a Cost-Plus-Fixed-Fee arrangement with a size standard of $19.5 million under NAICS code 541990 (All Other Professional, Scientific, and Technical Services). Teaming arrangements are permissible for interested small businesses, though if a small business set-aside is ultimately applied to the solicitation, at least 50 percent of contract performance costs must be expended on employees of the primary contractor and similarly situated subcontractors. The contract performance timeline and specific performance metrics will be further detailed in the final Statement of Work and formal solicitation documents. Small businesses interested in responding should review the attached Draft Statement of Work and Sources Sought Notification to fully understand the scope, technical requirements, and compliance standards for Medicare program integrity activities.