The Department of Health and Human Services, Centers for Medicare and Medicaid Services has a requirement for Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC).

CMS has traditionally used the PPI MEDIC for Medicare Parts C and D plan oversight, including audits, outreach and education, and data analysis. In January 2025, CMS contemplated separating the Part C and Part D functions of the traditional PPI MEDIC, releasing two separate Sources Sought Notifications (SSNs), the Medicare Drug Integrity Contractor (MEDIC) (250474J), which would focus on Part D audits, outreach and education, and data analysis, and the Part C Program Integrity Contractor (CPIC) (250475J), which would focus on Part C audits, outreach and education, and data analysis. Since this time CMS has reevaluated their approach and determined that the traditional version of the PPI MEDIC better aligns with the needs of the Agency.

Therefore, SSNs 250474J and 250475J are no longer relevant in terms of market research to support the procurement decisions related to the PPI MEDIC requirement.

The PPI MEDIC will continue to serve as the national contractor responsible for providing oversight of the Medicare Part C and Part D programs through supporting CMS’s strategy in maintaining and strengthening program integrity by monitoring and addressing program vulnerabilities, risks and ensuring plan sponsors’ adherence to regulatory requirements.

• The Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC), acting as an independent contractor and not as an agent of the government, shall perform fraud, waste and abuse (FWA) detection, deterrence, and prevention activities for Medicare Parts C and D programs. The PPI MEDIC shall furnish all the necessary services, qualified personnel, material, equipment, and facilities, not otherwise provided by the government, as needed to perform the work described in this Statement of Work (SOW). The PPI MEDIC’s work includes data analyses;audits and reviews of Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDPs), outreach and education, and referrals to law enforcement and other appropriate entities. The PPI MEDIC shall coordinate with staff from the Centers for Medicare & Medicaid Services (CMS), other CMS contractors, and other stakeholders as needed and as directed by the CMS Contracting Officer’s Representative (COR), in collaboration with Business Function Leads (BFL), to perform this program integrity work
• The PPI MEDIC shall perform a range of FWA proactive data analysis of Medicare data to support oversight of MAOs and PDPs. The PPI MEDIC shall analyze the applicable data, including data from multiple health care databases that are both internal and external to CMS, when performing their work. While awaiting data sources that may not be fully available, the PPI MEDIC shall collaborate with CMS to determine innovative approaches, to ensure the most complete and accurate data becomes available to perform data analysis work in pursuit of strong program integrity. This requirement applies to all of the following tasks