Draft Performance Work Statement 1

Performance Work Statement (PWS)

SECTION 1: Audit – Medicare Parts A, B, D and Medicaid

1.0 Background

The Office of Inspector General’s (OIG’s) mission is to provide objective oversight to promote the economy, efficiency, effectiveness, and integrity of Health and Human Services (HHS) programs, as well as the health and welfare of the people they serve. Since its establishment, OIG has been at the forefront of the nation’s efforts to fight waste, fraud, and abuse in Medicare, Medicaid, and more than 100 other HHS programs.
To carry out its mission, OIG conducts oversight activities, including audits, evaluations, and investigations. OIG is authorized to conduct audits, investigations and inspections of HHS programs and operations by the Inspector General Act of 1978, as amended, and exercises independence and discretion in doing so. OIG also conducts audits specifically mandated by Acts of Congress. Audits examine the performance of HHS programs and/or its grantees and contractors in carrying out their respective responsibilities and are intended to provide independent assessments of HHS programs and operations. These audits help reduce waste, abuse, and mismanagement and promote economy and efficiency throughout HHS. To carry out our mission, OIG’s work may require obtaining consultative services and medical record review to determine whether payments met program requirements. Reports containing the results of medical record review are typically publicly released and available on the OIG’s website. OIG conducts its work in accordance with Government Auditing Standards issued by the Comptroller General of the United States; the Single Audit Act Amendments of 1996; applicable Office of Management and Budget circulars; and other legal, regulatory, and administrative requirements. This section of the PWS outlines the requirements to provide successful and acceptable Medical Record Review support and Consultation Services and for the HHS OIG/Office of Audit Services, Medicare Parts A, B, D and Medicaid.

1.1 Scope

The scope of the resulting contract will include medical review and consultative services associated with the oversight activities of the OIG primarily involving Medicare Fee-For-Service (FFS) payments. Occasionally, it may include assessment of services and claims for Medicaid or Medicare Part D. Based on prior experience, the resulting contract(s) will require medical review of approximately 100 to 200 claims and associated medical records per audit and approximately