Request for Information – Interested Vendor Response

Request for Information (RFI) - Fraud Defense Contracts RFI Questions - Response Form

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The Centers for Medicare & Medicaid Services (CMS) works diligently to crush fraud in federal health care programs, including Medicare and Medicaid. A cornerstone of CMS' program integrity (PI) strategy is focused on using advanced analytics and other investigative techniques to identify potentially problematic actors and stopping them in their tracks. CMS has traditionally contracted with private entities to bolster our investigative capabilities and take appropriate administrative action, including imposing payment suspensions, revoking Medicare billing privileges, and referring potential fraud cases to states and appropriate law enforcement entities. Through this Request for Information (RFI), we are seeking creative ideas and solutions as to how a contractor might best address the draft Statement of Objectives (SOO). The draft SOO reflects the direction of the proposed future operating model, including a greater CMS role in lead development, prioritization, and direction of investigations. We encourage commenters to recommend innovative approaches for accomplishing the objectives within that framework and to identify where the framework creates risk. Within that framework, responses should not be constrained by traditional policies and processes, such as those in the current Unified Program Integrity Contractor (UPIC) Statements of Work or the Medicare Program Integrity Manual. We have also developed a list of specific questions for which we are seeking input; however, all ideas are welcome. Each question appears on its own page. Type your response in the box below the question. Responses are limited to 4,000 characters (including spaces); text will scroll within the box if it exceeds the visible area.

RFI Questions - Fraud Defense Contracts

Request for Information (RFI) - Fraud Defense Contracts

INVESTIGATIVE WORK AND OPERATING MODEL • QUESTION 1

1. What defines a successful PI model in 2026 and beyond? Provide examples of activities, technology, or other innovations that should be included in a new PI model focused on crushing fraud. How is this different or similar to the traditional investigative roles of the UPICs and predecessor contractors, such as the Zone Program Integrity Contractors (ZPICs)?
Response - character limit: 4,000 characters (including spaces). Text scrolls if longer.