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Fraud, Waste, and Abuse (FWA) Investigation Services

Active
State & Local

Contract Overview

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This subcontract for Fraud, Waste, and Abuse Investigation Services supports prime contractors on provider oversight projects for the Ohio Department of Medicaid. The selected provider will perform incident management and conduct detailed investigations into suspected fraud, waste, or abuse to provide the necessary evidence for enrollment denials, suspensions, or terminations. Key deliverables include the submission of comprehensive investigation reports and the maintenance of incident management logs. To qualify for this engagement, personnel must hold Certified Fraud Examiner credentials and be proficient in the use of case management software. The opportunity is categorized under NAICS code 541990 and is associated with the Ohio Medicaid Director. Interested parties should note the response deadline of December 4, 2026.

General Info

Fraud investigation services for Ohio Medicaid requiring CFE credentials by December 4, 2026.

Documents

This scope was carved out of ODMR 2627-0011.

The full solicitation package (1 document), including the RFP, is on the prime solicitation, not on this scope.

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ODMR 2627-0011 Provider Oversight RFI

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Organization & Contact Information

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AgencyOhio → Mcd000001 Medicaid Director Mcdlz5
ContactsNo contacts available
OfficeN/A
Office AddressN/A
ContactsNo contact information available

Full Description

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Performs incident management and investigative services for prime contractors on Ohio Department of Medicaid (ODM) provider oversight projects. Conducts investigations into suspected fraud, waste, or abuse to support enrollment denial, suspension, or termination. Requires Certified Fraud Examiner (CFE) credentials and use of case management software. Delivers investigation reports and incident management logs.

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NAICS: 541611
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ODMR 2627-0011 Provider Oversight RFI
Solicitation # ODMR 2627-0011
The Ohio Department of Medicaid (ODM) has issued Request for Information (RFI) ODMR 2627-0011 to gather data on tools, services, and measures to enhance provider enrollment and oversight activities. The primary objective is to prevent fraud, waste, and abuse within the Medicaid program, specifically focusing on the management and revalidation of approximately 30,000 providers in Home and Community Based Services waiver programs. Proposed solutions must integrate seamlessly with the Ohio Medicaid Enterprise Solution (OMES) and align with CMS guidance to revalidate all Medicaid providers within a two-year window. The scope of the RFI includes seeking information on eligibility screening, the management of on-site visits for various risk levels, the tracking of initial and revalidation applications, and methods for verifying provider location clustering and shared square footage compliance. Requirements also touch upon the use of standard credentialing forms from the Council for Affordable Quality Healthcare and adherence to state and federal confidentiality and privacy laws. This is an information-gathering effort for planning purposes and does not constitute a formal solicitation or a contract award. Interested parties must submit their responses as a single PDF document via the OhioBuys portal by December 4, 2026, at 2:00 pm EST.
Administrative Management and General Management Consulting Services

POSTED

2 days ago

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in about 1 month
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