|Contract Name||Centers for Medicare & Medicaid Services Unified Program Integrity Contractor (CMS UPIC)|
|Point of Contact|
Andrew Mannetti – Capture Lead, Federal Health
CMS currently relies on a select group of Government Contractors to support critical Program Integrity work under Medicare and Medicaid. The Unified Program Integrity Contracts combine work from the Zone Program Integrity Contractors (ZPICs), Program Safeguard Contractors (PSCs), Medicare-Medicaid Data Match (Medi-Medi) program, and the Medicaid Integrity Contractors (MICs) program. The Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) are under contract to perform specific Medicare program integrity functions. The Medicare-Medicaid Data Match (Medi-Medi) program is incorporated as a separate task order under the current ZPIC scope of work. The ZPICs are under contract to conduct Medi-Medi activities including matching Medicare and Medicaid data and investigating potential instances of fraud, waste, and abuse. The Medicaid Integrity Contractors (MICs) are under contract to perform specific Medicaid program integrity functions, including provider/supplier audits. The CMS UPIC Contract integrates these existing functions into a single contractor in a defined geographic area performing Medicare and Medicaid program integrity work on behalf of CMS.
The UPIC program is designed to:
- Integrate Medicare and Medicaid program integrity activities to support a holistic and coordinated Medicare and Medicaid program integrity strategy
- Set national goals and priorities to assure that local or regional program integrity activities are consistent with the CPIs national-level strategy, while still allowing for regional program integrity activities to respond to local or regional trends in fraud, waste and abuse
- Further enable cooperation, communication and sharing of information and best practices between the program integrity Contractors to assure a truly national approach to providers/suppliers or trends that cut across jurisdictions
- Adopt a data-driven approach to CMS’ national-level direction of the UPIC’s work by using timely and accurate information about the UPIC’s workload and activities
- Leverage CPI’s evolving centralized fraud detection mechanisms and other tools, for example the Fraud Prevention System predictive analytics tool (FPS) and the Healthcare Fraud Prevention Partnership (HFPP), across the entire nation
- Reduce improper payments caused by fraud, waste and abuse
Analytica is a leading consulting and information technology solutions provider to public sector organizations supporting health, civilian, and national security missions. Founded in 2009 and headquartered in Washington D.C., the company is an established SBA certified HUBZone and 8(a) small business that has been recognized by Inc. Magazine each of the past three years as one of the 250 fastest-growing companies in the U.S. Analytica specializes in providing software and systems engineering, information management, analytics & visualization, agile project management, and management consulting services. The company is appraised by the Software Engineering Institute (SEI) at CMMI® Maturity Level 3 and is an ISO 9001:2008 certified provider.