Program Integrity Medical Reviews

This contract entails performing detailed medical reviews aimed at identifying fraud, waste, and abuse within Medicare claims, thereby supporting the Centers for Medicare & Medicaid Services (CMS) in maintaining program integrity. The work is designated as a subcontract under the NAICS code 541611, which includes administrative management and general management consulting services. The Department of Health and Human Services, through its Office of Acquisition and Grants Management, is the agency overseeing this effort. The contract posting date is June 11, 2026, with a response deadline set for June 25, 2026, at 2:00 PM. The work will be performed primarily in St James, with a postal code of 21244. Although specific organizational types, set-aside classifications, and detailed point of contact information are not provided, the procurement focuses on ensuring that CMS programs reduce improper payments and improve Medicare claims processing integrity. This initiative contributes to safeguarding federal healthcare funds and enhancing the quality of service delivery in Medicare programs.