Medicare Fee-For-Service Corrective Action Strategic Analysis

This contract focuses on reducing improper payments in the Medicare Fee-For-Service program through advanced analytics and targeted corrective actions. By leveraging CERT data, the initiative identifies high-risk service types and recurring error categories while accounting for evolving legislative changes to prioritize areas with the greatest financial impact. The strategy integrates both prepay and post-pay review mechanisms, including TPE, PA, UPICs, and RACs, and evaluates their effectiveness using stakeholder insights and RACDW data to refine audit approaches and enhance oversight efficiency. The program emphasizes provider education and tool enhancement to address the root causes of billing errors, driving sustainable compliance improvements. Strategic assessments are conducted to align audit activities, regulatory updates, and reporting practices with return on investment goals, ensuring resources are directed toward the most impactful interventions. This effort is structured as a total small business set-aside under NAICS code 541611, with oversight managed by the Centers for Medicare and Medicaid Services and point of contact information provided for program and contracting inquiries.