Supplemental Medical Review Contract

The Supplemental Medical Review Contract is a sources-sought notice issued by the Office of Acquisition and Grants Management within the Department of Health and Human Services to identify qualified contractors capable of performing post-payment medical reviews and related activities in support of the Center for Program Integrity. The contracted work will center on ensuring program integrity for Medicare Fee-for-Service claims across Parts A, B, and DMEPOS by identifying fraud, waste, and abuse through comprehensive medical and non-medical record reviews, data analysis, claim scrubbing, extrapolation of overpayments, and appeals support at the Administrative Law Judge level. Offerors must demonstrate extensive operational experience with Medicare claims systems including the Common Working File, Integrated Data Repository, Unified Case Management System, and others, along with proven ability to manage high-volume workflows, conduct provider outreach, and maintain rigorous document management for medical record intake, imaging, printing, and tracking. The contract requires adherence to strict federal and HHS security and privacy standards, including compliance with FAR 52.239-1, HHSAR 352.239-71 and 352.239-72, NIST SP 800-53 and 800-171, FISMA, and the Privacy Act of 1974, alongside HIPAA and Section 508 accessibility mandates. All deliverables must be editable by the government, properly formatted, and submitted in both hard and electronic copy with full documentation of sanitization and offboarding procedures upon contract termination. Personnel must undergo annual CMS training in security, privacy, and records management, and the contractor must designate a Security Support Officer with at least five years of experience, including three in healthcare. The contract will be performed in St. James, Maryland, with reporting and deliverables due according to established timelines, including a Quality Control Plan within 14 days of award and monthly cost and performance reports on the 15th of each month. While this notice is not a solicitation and no award will result from it, responses are required to demonstrate full compliance with mandatory qualifications such as SAM registration, government-approved accounting systems, and socioeconomic certifications under NAICS 524114. Teaming arrangements are permitted, and prospective offerors must complete a non-disclosure agreement and provide detailed documentation on their technical, operational, and security capabilities as outlined in the attached Draft Statement of Work and supporting appendices.