Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC)
Overview
Buyer
Place of Performance
NAICS
PSC
Set Aside
Original Source
Timeline
Qualification Details
Fit reasons
- NAICS alignment with historical contract wins in similar service areas.
- Scope strongly matches core technical capabilities and delivery model.
Risks
- Past performance thresholds may require one additional teaming partner.
- Potential clarification needed on staffing minimums before bid/no-bid.
Next steps
Validate eligibility requirements, assign capture owner, and schedule partner outreach to confirm teaming strategy before submission planning.
Quick Summary
The Centers for Medicare and Medicaid Services (CMS) is soliciting proposals for a Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC). This national contractor will provide oversight for Medicare Parts C and D programs, focusing on fraud, waste, and abuse (FWA) detection, deterrence, and prevention to protect the Medicare Trust Fund. This is a Women-Owned Small Business (WOSB) Program Set-Aside.
Scope of Work
The PPI MEDIC will conduct comprehensive FWA activities, including:
- Data analysis, audits, and reviews of Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDPs).
- Outreach, education, and referrals to law enforcement.
- Specific audit types: Self-Audits, National Audits, Program Integrity (PI) Audits, and Ad hoc audits (including Part C Oversight Audits).
- Management of the first level of appeal (Reconsideration) for Part D program integrity PDE record review audits.
- Development of audit protocols, hosting FWA training, and generating quarterly reports. The Statement of Work (Attachment J.1 - Amendment 1) provides detailed requirements and updated workload projections (Exhibit E.3 - Amendment 1).
Contract Details
- Contract Type: Cost-Plus-Fixed-Fee (CPFF).
- Period of Performance: A base period from June 28, 2026, to June 27, 2027, plus five option years, extending through June 27, 2031, with an optional transition-out period.
- Set-Aside: Women-Owned Small Business (WOSB) Program Set-Aside. Offerors must be SBA-certified WOSB at Phase 1, Phase 2, and award.
Submission & Evaluation
This solicitation uses a two-phased Best Value Tradeoff Process, where technical factors are significantly more important than cost/price.
- Phase 1: Focuses on Technical Understanding and Approach.
- Notice of Intent Due: April 17, 2026, 10:00 AM local time, Baltimore, MD.
- Phase 1 Proposals Due: April 22, 2026, 10:00 AM local time, Baltimore, MD.
- Phase 2: Invited offerors will submit proposals covering Key Personnel, Staffing Plan, Past Performance, and a Business Proposal. The accounting system must be acceptable at Phase 2 submission.
- Required Submissions: Proposals must be structured into four volumes: Technical (Phase 1 & 2), Business (Phase 2), and 508 Compliance & Conflict of Interest (Phase 2).
- Key Attachments: Offerors must use the provided templates for the Business Proposal (Exhibit E.8 - Amendment 1), Responsibility Questionnaire (E.5), Past Performance Questionnaire (E.4), and Conflict of Interest (J.2). All deliverables must comply with Section 508 accessibility standards, using the provided checklists.
Important Notes
This solicitation has been amended (Amendment 1) to extend deadlines and clarify various sections of the Solicitation (L&M), SOW, and other exhibits. Offerors should refer to the latest amended documents for accurate information.