Recovery Audit Contract OCMP-26-25113 (RAC)

The Maryland Department of Health is soliciting proposals for a Recovery Audit Contract (OCMP-26-25113) to reduce Medicaid improper payments by identifying overpayments and underpayments and implementing preventative measures. The scope of work focuses on auditing claims for in-state general hospitals, out-of-state general hospitals, and in-state psychiatric hospitals. This is a Small Business Reserve Procurement, limiting the award to certified small businesses recognized by the Governor’s Office of Small, Minority & Women Business Affairs. The contract consists of three base years beginning August 1, 2027, with two optional one-year extensions, totaling a potential five-year term. The selected vendor will be compensated via a contingency fee based on actual recoveries received by the Department, with a specified fee of 10 percent of properly identified payments. To qualify, offerors must possess at least three years of hospital claims auditing experience within the last five years and maintain a conflict-of-interest free status regarding audited hospitals for the previous three years. Required staffing must include Physician, Registered Nurse, or Clinical Pharmacist Reviewers and Certified Professional Coders. The vendor is also required to maintain significant insurance coverages, including 5 million dollars for cyber security and data breach insurance. Award decisions will be based on the most advantageous proposal, with technical and financial factors weighted equally. Technical evaluation focuses on the work plan, staff qualifications, offeror capabilities, and economic benefit to the state. Proposals must be submitted via the eMaryland Marketplace Advantage portal in a two-part format consisting of a technical volume and a financial volume. Key deliverables include monthly status reports and a comprehensive work plan, with a proposed start-up period of 30 to 60 days.