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Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC)   3

ID: 260656J • Type: Solicitation • Match:  85%
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Description

Posted: April 15, 2026, 2:52 p.m. EDT

***Amendment 1 ***

75FCMC26R0041, Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC), is hereby amended as follows. All changes are identified in RED throughout the referenced documents:

Exhibit E.1 Solicitation Section L&M Amendment 1:

  • Page numbers have been added.
  • Section L.2(b) has been updated to extend the Notice of Intent submission date to April 17, 2026, by 10:00:00 AM, local time, Baltimore, MD.
  • Section L.3 has been updated to extend the Phase 1 proposal received date to no later than April 22, 2026, 10:00:00 AM local time, Baltimore, MD.
  • Section L.4(a) has been updated to provide clarification that Volume III and IV are part of the Phase 2 submission.
  • Section L.6 the section title has been updated to provide clarification that Volume III is part of the Phase 2 submission.
  • Section L.6(a) has been updated to correct the business proposal volume reference from II to III.
  • Section L.6(a)(5) has been updated to clarify that the accounting system determination will be made at the time of the Phase 2 proposal submission.
  • Section L.6(a)(10) has been updated to remove reference to Teaming Arrangements .
  • Section L.7 - the section title has been updated to provide clarification that Volume IV is part of the Phase 2 submission.
  • Section M.2 has been updated to clarify eligibility requirements.
  • Section M.5 has been updated to clarify that evaluations for Phase 1 and Phase 2 will be utilized in the tradeoff analysis to determine which proposal offers the best combination of technical capabilities and price to the Government.

Section J:

Exhibit E.2 PPI MEDIC Questions Submission Template has been replaced with Exhibit E.2 PPI MEDIC Questions Response - Amendment 1 and includes answers to questions that CMS determined to be necessary for proposal preparation.

Exhibit E.8 Business Proposal Template - Amendment 1- has been updated to removed text from row 152 that was unintentionally included in the template.

Exhibit E.8 Business Proposal Template - Amendment 1- has been updated to provide clarification to Offeror's that they should incorporate the costs associated with Task 1 in Attachment J.1 - PPI MEDIC - Statement of Work under Task 6 - Administrative Requirements.

Attachment J.1 PPI MEDIC Statement of Work Amendment 1 Section 2.6 Audits has been updated to provide clarification on Remedy Action Plans (RAPs) and Corrective Action Plans (CAPs).

Attachment J.1 PPI MEDIC Statement of Work Amendment 1 Section 2.6.2 Program Integrity (PI) Audits has been updated to include "and/or", to ensure flexibility in audit location (i.e. virtual or onsite).

Attachment J.1 PPI MEDIC Statement of Work Amendment 1 Section 3.1 Incoming Transition Requirements has been updated to include additional transition clarifications.

Attachment J.1 PPI MEDIC Statement of Work Amendment 1 Section 3.2 Outgoing Transition Requirements has been updated to include additional transition clarifications.

Attachment J.1 PPI MEDIC Statement of Work Amendment 1 Appendix A- Deliverables Schedule has been updated to include additional transition-out deliverables associated with SOW Section 3.2.

Attachment J.1 PPI MEDIC Statement of Work Amendment 1 Appendix A- Deliverables Schedule has been updated to renumber deliverables 19-32.

*** Original ***

The PPI MEDIC serves as a national contractor responsible for providing oversight of the Medicare Parts C and D programs to ensure the protection of the Medicare Trust Fund. CMS seeks to contract with an external entity to support CMS audits and program integrity oversight activities related to fraud, waste, and abuse efforts within the Medicare Parts C and D programs. Its tasks include data analysis, audits and reviews of Medicare Advantage Organizations (MAOs), including Medicare Advantage Prescription Drug (MA-PD) plan sponsors and Prescription Drug Plan (PDP) sponsors, as well as outreach, education, and referrals to law enforcement.

Posted: April 3, 2026, 7:17 a.m. EDT
Background
The Centers for Medicare & Medicaid Services (CMS) seeks to contract with an external entity, known as the Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC), to provide oversight of the Medicare Parts C and D programs.
The goal of this contract is to ensure the protection of the Medicare Trust Fund by supporting CMS audits and program integrity oversight activities related to fraud, waste, and abuse efforts within these programs.

Work Details
The contractor will perform various tasks including: monitoring and addressing program vulnerabilities, conducting data analysis, performing audits and reviews of Medicare Advantage Organizations (MAOs), including Medicare Advantage Prescription Drug (MA-PD) plan sponsors and Prescription Drug Plan (PDP) sponsors.
Additionally, the contractor will be responsible for outreach, education, and referrals to law enforcement.
The work is detailed in the PPI MEDIC Statement of Work (SOW), provided as Attachment J.1.
The contractor must furnish all necessary services, qualified personnel, material, equipment, and facilities required to perform the tasks outlined in the SOW.

Period of Performance
The contract has multiple performance periods: from June 28, 2026 to June 27, 2027; June 28, 2027 to June 27, 2028; June 28, 2028 to June 27, 2029; June 28, 2029 to June 27, 2030; June 28, 2030 to June 27, 2031; and an optional transition-out period from March 28, 2031 to June 27, 2031.

Overview

Response Deadline
April 22, 2026, 10:00 a.m. EDT (original: April 17, 2026, 10:00 a.m. EDT) Due in 5 Days
Posted
April 3, 2026, 7:17 a.m. EDT (updated: April 15, 2026, 2:52 p.m. EDT)
Set Aside
Women-Owned Small Business (WOSB)
Place of Performance
MD 21244 United States
Source

Current SBA Size Standard
$19.5 Million
Pricing
Multiple Types Common
Est. Level of Competition
Average
Est. Value Range
Experimental
$50,000,000 - $150,000,000 (AI estimate)
Signs of Shaping
94% of obligations for similar contracts within the Centers for Medicare and Medicaid Services were awarded full & open.
On 4/3/26 CMS Office of Acquisition and Grants Management issued Solicitation 260656J for Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC) due 4/22/26. The opportunity was issued with a Women-Owned Small Business (WOSB) set aside with NAICS 541990 (SBA Size Standard $19.5 Million) and PSC R499.
Primary Contact
Name
Jennifer Kuhn   Profile
Phone
(410) 786-2299

Secondary Contact

Name
Kyle Patton   Profile
Phone
(410) 786-8714

Documents

Posted documents for Solicitation 260656J

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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
April 15, 2026
Last Updated By
jennifer.kuhn@cms.hhs.gov
Archive Date
June 30, 2026