This Solicitation opportunity from North Carolina was posted on February 26, 2025. The submission period has ended. Browse the details below for market research, or find similar active opportunities.

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Statewide Program Integrity Administrator for Fraud, Waste, and Abuse Management

Closed

Doc1480247003State & Local

Submission Closed05/08/2025, 12:00:00 AM UTC

Contract Overview

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

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NAICS: 541211

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Solicitation # 2140313

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Town of Middleborough

POSTED

1 day ago

DEADLINE

in 27 days

AI Contract Overview

The North Carolina Department of Health and Human Services, through its Division of Health Benefits, is seeking a qualified partner to serve as the Program Integrity Administrator for its Fraud, Waste, and Abuse program within NC Medicaid. The selected contractor will be responsible for overseeing a comprehensive suite of program integrity functions, including prepayment and postpayment claims reviews, data analytics, medical necessity assessments, investigations, and provider audits. This role also involves managing recovery audit contracts and conducting non-RAC provider audits to ensure compliance and prevent fraudulent activities within the Medicaid program. The contract aims to secure an experienced entity capable of managing these complex functions across a statewide scope, with a contract value estimated between 5 million and 15 million dollars. The solicitation was posted on February 26, 2025, with a response deadline of May 8, 2025. Interested organizations can find additional details and submit responses through the official procurement portal. This initiative underscores the Department’s commitment to safeguarding Medicaid resources through robust program integrity measures.

General Info

Agency

North Carolina Department of Health and Human Services

NAICS

541211 - Offices of Certified Public Accountants

Place of Performance

NC, USA

Set-Aside

NONE

Documents

RFP #30-2025-004-DHB: Statewide Surveillance for Fraud, Waste and Abuse

rfp

High

AI Contract Breakdown

Uniform Contract Format

Timeline

PhaseClosed

PostedFeb 26

Solicitation

Response DeadlineMay 8

Deadline has passed

Submission Closed

05/08/2025, 12:00:00 AM UTC

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Organization & Contact Information

AgencyNorth Carolina Department of Health and Human Services

ContactsNo contacts available

OfficeN/A

Organization / AgencyNorth Carolina Department of Health and Human Services

Office AddressN/A

ContactsNo contact information available

Full Description

The North Carolina Department of Health and Human Services (“NCDHHS” or “Department”), Division of Health Benefits (“DHB” or “NC Medicaid”), through the Office of Compliance and Program Integrity (OCPI) seeks to procure an experienced and qualified partner to serve as the Fraud, Waste, and Abuse (FWA) Program Integrity Administrator. The selected Offeror shall be responsible for administering program integrity functions for (i) Prepayment Claims Reviews, (ii) Post Payment Claims Reviews, (iii) Data Analytics, (iv) Medical Necessity Reviews, (v) Investigations, (vi) Recovery Audit Contracts (RAC), and (vii) non-RAC Provider Auditing Activities.