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Medicare Drug Integrity Contractor (MEDIC)

ID: 250474J • Type: Sources Sought

Description

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

Background
The Centers for Medicare & Medicaid Services (CMS) is issuing this Sources Sought Notice to assess the availability and capability of potential small businesses to support the Medicare Drug Integrity Contractor (MEDIC) initiative.

The MEDIC's primary mission is to conduct fraud, waste, and abuse (FWA) detection, deterrence, and prevention activities for the Medicare Part D program. This initiative aims to protect the Medicare Trust Fund through effective oversight and collaboration with various stakeholders, including federal, state, and local agencies.

Work Details
The MEDIC will perform a range of tasks including:
1. Conducting audits of Medicare Advantage Prescription Drug (MA-PD) plans and stand-alone Prescription Drug Plan Sponsors (PDPs).
2. Performing data analyses to identify trends and patterns indicative of FWA.
3. Developing and managing Peer Activity Reports (PARs) that compare utilization trends among plan sponsors, prescribers, or pharmacies.
4. Issuing Plan Sponsor Alerts (PSAs) to notify plan sponsors of identified trends related to FWA.
5. Sending Targeted Compliance Notifications (TCNs) to plan sponsors whose audit results indicate noncompliance with CMS guidance.
6. Managing the CMS Part D Plan Correspondence Mailbox for communication with plans.
7. Conducting outreach and education missions aimed at reducing FWA through collaboration with MA-PDs and PDPs.
8. Implementing a records management program that includes retention protocols for various types of records related to FWA activities.

Place of Performance
The contract work will primarily be performed in locations designated by CMS, which may include federal, state, and local government offices.

Overview

Response Deadline
Jan. 28, 2025, 11:00 a.m. EST (original: Jan. 21, 2025, 11:00 a.m. EST) Past Due
Posted
Jan. 7, 2025, 12:26 p.m. EST (updated: Jan. 15, 2025, 7:51 a.m. EST)
Set Aside
Small Business (SBA)
Place of Performance
Baltimore, MD United States
Source
SAM

Current SBA Size Standard
$19.5 Million
Pricing
Multiple Types Common
Est. Level of Competition
Low
Est. Value Range
Experimental
$50,000,000 - $150,000,000 (AI estimate)
Odds of Award
10%
Signs of Shaping
94% of obligations for similar contracts within the Centers for Medicare and Medicaid Services were awarded full & open.
On 1/7/25 CMS Office of Acquisition and Grants Management issued Sources Sought 250474J for Medicare Drug Integrity Contractor (MEDIC) due 1/28/25. The opportunity was issued with a Small Business (SBA) set aside with NAICS 541990 (SBA Size Standard $19.5 Million) and PSC R499.
Primary Contact
Name
Charlene Barnes   Profile
Phone
(410) 786-8827

Secondary Contact

Name
Jennifer Kuhn   Profile
Phone
(410) 786-2299

Documents

Posted documents for Sources Sought 250474J

Question & Answer

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Additional Details

Source Agency Hierarchy
HEALTH AND HUMAN SERVICES, DEPARTMENT OF > CENTERS FOR MEDICARE AND MEDICAID SERVICES > OFC OF ACQUISITION AND GRANTS MGMT
FPDS Organization Code
7530-75FCMC
Source Organization Code
500019128
Last Updated
Feb. 12, 2025
Last Updated By
jennifer.kuhn@cms.hhs.gov
Archive Date
Feb. 12, 2025