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Healthcare Fraud Investigative Services

Active
Federal

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

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The Healthcare Fraud Investigative Services subcontract, managed by the Department of Health and Human Services Office of Acquisition and Grants Management, involves providing field-based investigative support for CMS Program Integrity projects. The selected contractor will be responsible for conducting interviews with providers, suppliers, and beneficiaries, as well as collecting documentary evidence and executing fraud investigations within specific jurisdictions. All findings must be thoroughly documented and supported by evidence using specialized investigative tools. Due to the nature of the work and required coordination with the FBI and DOJ, personnel must undergo comprehensive background checks. This opportunity falls under NAICS code 561611, with a response deadline of November 4, 2026. The primary objective is to deliver high-quality investigative results that assist prime contractors in maintaining the integrity of healthcare programs.

General Info

NAICS

561611 - Investigation and Personal Background Check Services

Place of Performance

0, MD, 21244, USA

Set-Aside

NONE

Documents

This scope was carved out of 270536 .

The full solicitation package (2 documents), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

Request for Information - Fraud Defense Contracts

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Timeline

Posted

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Response Deadline

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Organization & Contact Information

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AgencyDepartment Of Health And Human Services → Ofc Of Acquisition And Grants Management
ContactsNo contacts available
OfficeN/A
Office AddressN/A
ContactsNo contact information available

Full Description

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Performs boots-on-the-ground investigative activities for prime contractors on CMS Program Integrity projects. Conducts provider, supplier, and beneficiary interviews, collects document evidence, and executes fraud investigations within assigned jurisdictions. Utilizes investigative tools for evidence collection and documentation. Requires background checks for interaction with FBI and DOJ. Delivers investigative findings supported by evidence and documentation.

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NAICS: 561611
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Solicitation # 270536
The Centers for Medicare & Medicaid Services (CMS) has issued a Request for Information (RFI) under solicitation number 270536 to gather industry feedback and innovative solutions for its future Fraud Defense Contracts. The primary objective is to enhance Program Integrity (PI) efforts to combat fraud and abuse within federal health care programs, specifically Medicare and Medicaid. CMS is proposing a new operating model that increases its own role in lead development, prioritization, and the direction of investigations. The agency is seeking input on the use of advanced analytics, artificial intelligence, SQL, and open-source intelligence (OSINT) to identify problematic actors and develop defensible law enforcement referral packages and administrative actions, such as payment suspensions and revocations. Interested vendors must submit their responses using the designated Interested Vendor Response form by 11 AM EST on November 4, 2026. The scope of work involves collaborating with various entities, including the Department of Justice, FBI, and the HHS Office of Inspector General, while maintaining strict security, privacy, and evidentiary safeguards. CMS is particularly interested in feedback regarding fixed-price contracting structures and strategies to mitigate organizational conflicts of interest for firms with existing health plan or provider business. This RFI is for informational and planning purposes only, and no contract will be awarded based solely on the responses provided.
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