Request for Information Medicare Part C & D Integrity Contractors

Background
The Centers for Medicare & Medicaid Services (CMS) intends to procure services for audit and fraud, waste, and abuse (FWA) detection, deterrence, and prevention activities specifically for Medicare Part C and Part D. This initiative aims to consolidate the program integrity work previously performed by two contractors: the Investigations Medicare Drug Integrity Contractor (I-MEDIC) and the Plan Program Integrity (PPI)-MEDIC. The goal is to enhance the integrity of Medicare programs by proactively addressing FWA issues.

Work Details
The Medicare Drug Integrity Contractor (MEDIC) will perform a range of tasks including:
1. **Fraud, Waste, and Abuse Detection**: Conducting audits of Medicare Advantage Prescription Drug (MA-PD) plans and Part D Plan Sponsors (PDPs), focusing on complaint intake, data analysis, investigative actions, administrative remedies, and referrals.

2. **Coordination with CMS**: Working closely with CMS staff and other stakeholders to ensure compliance with federal regulations and effective program integrity efforts.

3. **Audit Development**: Creating audit plans that outline methodologies, steps, and timeframes necessary to meet audit objectives.

4. **Technical Assistance**: Providing technical support through proactive data analysis of Medicare data to assist in audits.

5. **Reporting**: Producing detailed reports on data analytics related to FWA efforts for MA-PDs and PDPs.

6. **Call Center Operations**: Operating a Call Center for reporting potential FWA incidents related to MA Plans, Part D Plan prescribers, pharmacies, and beneficiaries.

7. **Complaint Management**: Documenting complaints received via various channels and referring them as necessary while maintaining logs in an internal system.

8. **Investigation Coordination**: Collaborating with law enforcement agencies when necessary for investigations related to FWA.

Place of Performance
The services will primarily be performed within the United States as directed by CMS.