CMS Sources Sought: CPI Statistical Sampling & Overpayment Estimation (SSOE)

Notices

Notice ID: 211071

The Centers for Medicare & Medicaid Services (CMS) is hereby conducting market research to identify small businesses only to support informed decisions to procure services to support CMS, and specifically the Center for Program Integrity (CPI), in its Statistical Sampling & Overpayment Estimation (SSOE).

The purpose of this contract is to support the Center for Program Integrity (CPI) in its efforts to provide statistical expertise on extrapolation and estimation of overpayments and to provide expert evaluation and guidance through the appeals process as requested by CMS.  The Contractor serves an essential role in performing a review of statistical methodologies and provides recommendations on supporting or recommending adjustments to overturned PI contractor estimation methodology.  In addition, the Contractor will review and provide recommendations on the consistency of required documentation used by statistical experts to CMS and advise on revisions required for the PIM, section 8.4.

Given the oftentimes large difference between an actual overpayment (limited to the sample) and an extrapolated overpayment (projected from the sample), it is critical that the process for reviewing extrapolations within the administrative appeals process be fair and reasonably consistent. In the first and second levels of the appeals process, such extrapolated overpayments are reviewed by MACs and QICs, respectively.

The Contractor shall monitor and track all extrapolations and estimations created by the Unified Program Integrity Contractors (UPICs) as well as the MAS to monitor appealed methodologies. Upon review of overturned methodologies on appeal, the contractor shall recommend more clarity on the type of approaches and documentation needed. In the case, where methodologies conducted by the UPIC are reviewed unfavorably in the appeals process, the contractor will offer expertise to strengthen and support UPIC findings per the instructions of the PIM. This effort will be documented for use as a future resource for CMS and UPIC. The contractor will make themselves available for any hearings to support their findings.

In addition, the contractor shall support CPI in providing responses to periodic ad hoc analytical requests that require sampling and estimation. In particular, the Contractor shall provide expert advice, analysis, and recommendations for methodological approaches related to the recoupment of funds as requested by CMS. These approaches will contribute to the knowledge base and will be maintained as a future resource by CMS.

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