SAM #140D0427Q0883

DOI Market Research for Medical Review, Audit, and Expert Witness Support

The Department of the Interior is conducting market research for medical review and expert support described in a draft scope for HHS Office of Inspector General programs. - Government buyer and scope - The RFI is issued by the Department of the Interior (DOI), through the Interior Business Center Acquisition Services Directorate. - The draft Performance Work Statement describes support for the Department of Health and Human Services (HHS), Office of Inspector General (OIG), including the Office of Audit Services (OAS), Office of Evaluation and Inspections (OEI), Office of Investigations (OI), and Office of Counsel to the Inspector General (OCIG). - Services requested - Medical record reviews, audits, and consultation for Medicare Parts A, B, and D and Medicaid, including assessment of claims, medical necessity, coding, documentation, quality of care, and adverse events. - Medicare Part C review, including validation of diagnoses and Hierarchical Condition Categories (HCCs), coding review, and reporting. - Clinical consultation and record review for program evaluations and inspections, including care, patient harm, medical necessity, coding comparisons, and data analysis. - Medical expert support for investigations and litigation, including record and billing review, expert opinions and reports, trial preparation, and testimony; possible forensic or pathology consultation is also described. - Workload and requirements - For Parts A, B, and D and Medicaid audits, the draft scope estimates about 100–200 claims per audit and about 1,500 claims annually across approximately 15 audits; actual workload may vary. - Evaluations and inspections may require medical-review consulting for zero to three evaluations per year, with occasional clinical consultations. - The work calls for qualified clinical and coding staff, secure handling of sensitive records, quality assurance, and Spanish-language capability when needed. OI work may involve variable, case-specific effort. - OCIG support may include review of provider credentials, medical records, billing, and related documents, as well as attorney consultation and authorized litigation support. - OEMs, vendors, and products - No OEMs, vendors, named commercial products, part numbers, or hardware are identified. No fixed product quantities are requested. - Potential commercial competitors—not named in the RFI—may include Cotiviti, Optum, MAXIMUS, and Guidehouse for relevant clinical review, payment integrity, audit, or consulting capabilities. - RFI purpose - This is market research, not a request for proposals or quotations. DOI seeks information on corporate capabilities, nationwide experience and capacity, technical and quality approaches, staffing, past performance, cost drivers, and feedback on the draft scope.

Description

This Request for Information (RFI) is issued in accordance with FAR Part 10 to conduct market research. The Government's purpose is planning only; this notice does not constitute a Request for Proposal (RFP)/Request for Quotation (RFQ) nor a promise to issue one in the future. The Government will not pay any costs for responding, and any submissions become Government property and will not be returned. Not responding to this RFI does not preclude participation in any future procurement. The Government is not seeking proposals or quotes at this time. Scope of Interest / Functional Areas:The Government is assessing the market¿s capability to provide comprehensive support under the following disciplines:a. Audits for Medicare Parts A, B, D, and Medicaid medical record review and consultative servicesb. Audits for Medicare Part C medical record review and consultative servicesc. Evaluations and Inspections medical record review and consultative servicesd. Expert consultant and witness services in support of the Office of Investigations and/or Office of Counsel to the Inspector General A draft Performance Work Statement (PWS) is provided for industry feedback; requirements may change prior to any future solicitation. Requested Information (do not submit proposals or quotes):Please provide high level, non price specific information addressing the elements below. Do not include proprietary pricing, line item estimates, or any proposal/quote content.Section 1: Corporate Capability & Experiencea. PWS Alignment: Demonstrate your organization's core capability to fulfill the functional areas outlined in the draft PWS.b. Medical Review Experience: Outline your firm's high-level experience in conducting large-volume medical claims reviews for audits and evaluations and inspections; and support services for medical expert consultants and witnesses specifically across the following five domains (as referenced in the attached PWS):1. Audit Medicare Parts A/B/D and Medicaid2. Audit Medicare Part C3. Evaluations and Inspections4. Office of Investigations5. Office of Counsel to the Inspector General c. Geographic Reach: Describe your prior experience managing and executing nationwide or multi-jurisdictional medical claim reviews.d. Capacity & Scalability: State your organization's maximum monthly claim review capacity, including your approach to scaling operations between normal workloads and surge conditions.e Teaming & Subcontracting: Identify potential subcontracting partners or specialized vendors you would anticipate utilizing, including an estimated percentage breakdown of work performed by the prime contractor versus subcontractors.Section 2: High-Level Technical Approach & Operationsa. High-Level Technical Methodology: Describe your conceptual approach to fulfilling the core tasks in PWS. Please limit this narrative to no more than 5 pages total, organized by the 5 PWS sections. Focus on your overarching claims review methodology, general sampling plan frameworks, documentation standards, and typical project timelines rather than a granular, step-by-step solution.b. Quality & Accuracy Frameworks: Outline your corporate quality assurance processes, internal review protocols, and standard strategies used to reduce error rates and ensure consistency across large volumes.b. Staffing & Key Qualifications: Provide a conceptual staffing structure or organizational chart. Identify the typical roles, credentials (e.g., MD, RN, CPC), and qualifications of the key personnel required to successfully support a PWS of this nature. Please identify whether these staff will need to be hired or if they are current employees/contractors. Also, indicate staffing availability for physicians with specialties (i.e. hospice, vascular surgeon, nephrologist, physical medicine and rehabilitation or physiatrists).c. Risk & Mitigation: Identify the primary technical or operational challenges anticipated with a medical review scope of this size and outline your high-level mitigation strategies.Section 3: Past Performance & Market Pricinga. Relevant Past Performance: Provide up to three examples of similar Federal medical review contracts performed within the last five years. Also, provide up to three examples of similar Federal support services for medical expert consultants and witnesses within the last five years.b. Performance Outcomes: Summarize the high-level outcomes of those past contracts, focusing on standard metrics such as timeliness, accuracy rates (including rate at which findings were overturned during the appeals process), and a history of successful audit findings.c. Cost Drivers & Efficiencies: Provide a general overview of your commercial pricing structure and the primary cost drivers (e.g., specific labor categories, specialized technology/AI tools, administrative overhead). Highlight any built-in efficiencies or innovative workflows in your approach that typically yield cost savings for the government.Section 4: Industry Feedback & PWS Refinementa. Clarity & Feasibility Review: Identify any requirements, metrics, or tasks within the draft PWS that appear ambiguous, overly restrictive, or technologically infeasible based on current commercial market capabilities.b. Recommendations for Improvement: Suggest specific enhancements, industry standard metrics, or structural changes to the PWS that would improve the clarity, feasibility, and competitiveness of the final solicitation.Submission Instructions:Email responses by November 13, 2026, 12:00 PM Eastern Time to the Points of Contact below. Mark proprietary information clearly; the Government may use non proprietary information to refine its acquisition approach. Points of Contact:a. Contracting Officer: Shavonda Jamison ¿ Shavonda_Jamison@ibc.doi.gov b. Contracting Specialist: Dorothy Royster ¿ Dorothy_Royster@ibc.doi.gov Attachments:a. Draft PWS (for market research and feedback only; subject to change). Disclaimer:This RFI is for market research; it does not commit the Government to any acquisition. The Government will not reimburse costs for responding. Not responding does not preclude participation in any future solicitation. No proposals or quotes will be accepted in response to this notice.

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