Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC)

Summary (Newest Update)

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.