SAM #270536

CMS RFI for Future Fraud Defense Contracts and Program-Integrity Investigative Support

CMS is seeking industry input on a proposed operating model for future Fraud Defense Contracts supporting Medicare program-integrity investigations. - Opportunity: Request for Information (RFI) only; CMS is gathering feedback on its draft Statement of Objectives and proposed contractor roles. This notice is not a solicitation or a contract award. - Potential work: Support CMS-assigned investigations through data analysis, targeted pre- and post-payment medical review, interviews, evidence collection, and investigative reporting. - Possible outcomes supported: Develop and support administrative and enforcement actions, including payment suspensions, revocation referrals, law-enforcement referrals, appeals, hearings, and litigation support. - Operational requirements: Provide qualified staff and surge capacity, maintain records in CMS-designated systems, protect sensitive information, coordinate with CMS and partners such as HHS OIG, DOJ, FBI, and Medicare Administrative Contractors, and support transition of active matters. - CMS oversight: CMS-assigned work takes priority. Contractor-developed leads, tools, new technologies, and material process changes require CMS review, approval, and direction before use. - Vendor response: Submit the provided interested-vendor response form. Vendors may answer some or all questions, subject to a 4,000-character limit per question. Responses are for planning purposes and will not affect evaluation in a future procurement. - Commercial details: No OEMs, specific products, quantities, part numbers, contract value, or award are identified.

Description

   1. Overview

        1.1 Introduction

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) (see Attachment 3.1). 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.

Please note that this RFI is for informational purposes only, and no contract will be awarded as a result. A firm or organization’s response to the RFI⁠—or lack thereof—will have no impact on the evaluation of responses to any subsequent Request for Proposals (RFP),  Request for Quote (RFQ), or Solicitation released. Responses will be used solely for information and planning purposes. No reimbursement will be made for any costs associated with providing information in response to this Request.

        1.2 RFI Contact

We have designated the following individual to serve as the official point of contact for this RFI. This individual is the only authorized contact permitted to communicate on behalf of CMS about this RFI.

               Jennifer Kuhn, Contracting Officer

               Office of Acquisition and Grant Management/ CMS

               Jennifer.Kuhn@cms.hhs.gov

        1.3 Submission Details

Please submit ONLY your completed Attachment 3.2, Request for Information – Interested Vendor Response, via email to the RFI point of contact no later than 11 AM EST on November 4, 2026.  THIS IS NOT A REQUEST FOR CAPABILITY STATEMENTS. 

   2. Information Requested

Interested Vendors are asked to complete the attached fillable PDF (Attachment 3.2, Request for Information – Interested Vendor Response).  Vendors must complete all entity related information, but may respond to some or all questions.  Please note that there is a 4,000-character limitation for each question.

Following review of the RFI responses, CMS reserves the right to follow-up with individual respondents to further discuss information provided in their submissions and obtain additional industry feedback relevant to the Fraud Defense Contracts.

   3. Attachments

          3.1 Draft Fraud Defense Contracts Statement of Objectives

          3.2 Request for Information – Interested Vendor Response

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