Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC) 260656J

This Sources Sought Notice is being issued to determine the availability and capability of potential small businesses (SBs) (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 Centers for Medicare & Medicaid Services (CMS), and specifically the Center for Program Integrity (CPI), in its Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC) work focused on conducting fraud, waste, and abuse (FWA) detection, deterrence, and prevention activities for Medicare Parts C and D by focusing primarily on data analyses, audits and reviews of Medicare Advantage Organizations (MAOs) (including Medicare Advantage Prescription Drug (MA-PD) plans) and stand-alone Prescription Drug Plan Sponsors (PDPs), outreach and education, and referrals to law enforcement and other appropriate entities. The desired outcomes of these efforts are to work collaboratively with MAOs, MA-PDs, and PDPs through outreach and education, to reduce FWA, and conduct audits of MAOs, MA-PDs and stand-alone PDPs thoroughly and in a timely manner and take immediate action to ensure that the Medicare Trust Fund is protected. See attached, Draft Statemet of Work (SOW) and Sources Sought Notification (SSN) for additional details .

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.

***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.