The Centers for Medicare & Medicaid Services'(CMS) mission is to ensure health care security to all beneficiaries. In carrying out this mission, CMS is dedicated to the highest integrity of its programs and has contracted with various entities for benefit integrity functions. Originally, program integrity efforts were aligned with CMS' fiscal intermediaries and carriers. The recent enactment of section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) changes CMS' current contracting structure by phasing out the fiscal intermediaries and carriers and phasing in the Medicare Administrative Contractors (MAC) for CMS Medicare claims processing. As a result of the MMA and the adoption of the MAC strategy, a realignment of the program integrity jurisdictions is necessary so that workloads align with the new MACs. In addition, the future intent of these realignments is to have one program integrity contractor be responsible for the detection, deterrence and prevention of fraud, waste, and abuse across all claim types.CMS has established seven (7) jurisdictional zones to deal efficiently with fraud, waste and abuse issues which also align effectively with multiple MAC jurisdictions. CMS will be procuring the seven (7) zones in three (3) separate cycles.



CMS anticipates releasing a solicitation for three (3) zones as follows:

Zone 4: Texas, Oklahoma, Colorado, and New Mexico.

Zone 7: Florida, Puerto Rico, and the U.S. Virgin Islands.

Zone 5: West Virginia, Virginia, North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas, and Louisiana.



It is anticipated that three (3) separate stand alone single IDIQ contracts will be awarded for each zone with a base period plus 4 option years. CMS intends to solicit this requirement as a full and open competition. This announcement is not a request for proposal (RFP). CMS anticipates release of Request for Proposal in early October 2007. The solicitation will be available on the Federal Business Opportunities (FedBizOpps) website. It is anticipated that this cycle will be awarded before May 31, 2008.



CMS will hold a Pre-proposal Conference on October 17, 2007 at the Centers for Medicare & Medicaid Services, Baltimore, MD. More details will be provided with the release of the solicitation.



Points of Contact

Theresa Schultz, Contracting Officer, Phone 410-786-8496, Fax 410-786-9088, Email theresa.schultz@cms.hhs.gov; Gina Romano, Contract Specialist, Phone 410-786-8645, Fax 410-786-9643, Email gina.romano@cms.hhs.gov

Zone 4: Texas, Oklahoma, Colorado, and New Mexico has been awarded to Health Integrity LLC. Zone 7: Florida, Puerto Rico, and the U.S. Virgin Islands has been awarded to SafeGuard Services, LLC. Zone 5: West Virginia, Virginia, North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas, and Louisiana have been awarded to AdvanceMed Corporation.