SOLICITATION NOTICE
D -- Fraud Prevention System ("FPS")2 - FPS2 Statement of Work
- Notice Date
- 4/22/2015
- Notice Type
- Presolicitation
- NAICS
- 541512
— Computer Systems Design Services
- Contracting Office
- Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of Acquisition and Grants Management, 7500 Security Blvd., C2-21-15, Baltimore, Maryland, 21244-1850
- ZIP Code
- 21244-1850
- Solicitation Number
- CMS-150097
- Archive Date
- 5/22/2015
- Point of Contact
- Donald E. Bozimski, Phone: 4107861355, Tonya D. Anderson, Phone: 4107684087
- E-Mail Address
-
donald.bozimski@cms.hhs.gov, tonya.anderson@cms.hhs.gov
(donald.bozimski@cms.hhs.gov, tonya.anderson@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Description
- Statement of Work for the Fraud Prevention System ('FPS') 2 requirement THIS PRESOLICITATION NOTIFICATION IS FOR A FULL AND OPEN ACQUISITION. THIS NOTICE IS NOT A REQUEST FOR PROPOSALS. In accordance with FAR 5.203(a), this synopsis provides at least 15 days notification that the Centers for Medicare & Medicaid Services (CMS) intends to issue a solicitation to obtain a second generation of the Fraud Prevention System ("FPS2") and associated operational services to support the workload of Centers for Medicare & Medicaid Services ("CMS") program integrity ("PI") contractors across the Medicare and Medicaid programs. The requirement is a full and open competition. It is anticipated that the solicitation will be posted to the Federal Business Opportunities (FBO) web site in April 2015. The purpose of this requirement is to acquire a second generation of the Fraud Prevention System ("FPS2") and associated operational services to support the workload of Centers for Medicare & Medicaid Services ("CMS") program integrity ("PI") contractors across the Medicare and Medicaid programs. The Contractor, acting independently and not as an agent of the government, shall furnish all the necessary services, qualified personnel, material, equipment, supplies, and facilities except as otherwise specified herein, and otherwise do all things necessary for or incident to performance of requirements described in the DRAFT Statement of Work (SOW). As required by the Small Business Jobs Act of 2010 (Public Law 111-240) mandates the use of predictive modeling and other analytic technologies to identify and prevent fraud, waste, and abuse in the Medicare FFS program. The Centers for Medicare & Medicaid Services ("CMS") developed and implemented the Fraud Prevention System to implement predictive analytics technologies to identify and prevent the payment of fraudulent claims in the Medicare Fee-for-Service Program. The vision of the Fraud Prevention System (Version1, identified in the draft SOW as FPS1) was to establish predictive modeling tools into the claims processing system to stop payment on high risk claims. The outputs of the modeling included risk scores and proposed actions (e.g. denial, payment suspension, investigation, revocation, etc.) and appropriate data to support the actions. CMS Center for Program Integrity ("CPI") is measured on Return on Investment ("ROI") of the FPS Program. To improve CPI's long-term ROI and align with CPI's organizational goal, FPS (Version 2, known in the DRAFT SOW as FPS2) is being undertaken to enable more efficient time-to-market for predictive models, better monitoring models and the ability to leverage more advanced modeling paradigms (such as Social Network Analysis). By investing in FPS2 system, CMS expects a range of benefits, including cost savings in operational IT infrastructures, improved cost recovery from administrative actions, improved prevention and detection of fraud, waste, and abuse in Medicare and Medicaid program spending. More detailed information about CMS PI activities is available at http://www.stopmedicarefraud.gov/ FPS1 provided a source of leads for CMS and Medicare PI contractors. The FPS1 applies predictive models and other algorithms to identify providers/suppliers exhibiting a pattern of behavior that is indicative of potential fraud, waste and abuse. The FPS1 system screens all Medicare FFS claims and builds profiles to help identify suspect behavior. FPS1 generates alerts based on billing behaviors, calculates a priority score, and assigns the alert to a PI contractor based on jurisdiction. FPS1 alerts may be assigned to a lead PI contractor and also allow for a participating PI contractor with shared workload responsibility. FPS1 priority scores are calculated and then prioritized list of alerts is updated in real time within the system. Alerts are stored in an Oracle database. PI contractors rule on FPS1 alerts based on the provider, not on individual alerts. The FPS1 system screens all national Medicare Part A, Part B, and DME claims during the adjudication process and consolidates alerts by provider. Medicare Parts C and D, and Medicaid information will be added as it becomes available in the IDR. The purpose of this contract is to implement FPS2 predictive modeling and other analytic technology systems that are capable of reporting alerts based on risk scoring applied to near real-time claims and increase CMS CPI Return on Investment ("ROI"). The system shall capture and detect patterns or anomalies through development of provider and beneficiary profiles, identifying potential fraud, waste and abuse by the methods listed below for Medicare Part A, Part B and DME claims:   • Provider billing patterns • Beneficiary utilization patterns • Use of social network analysis and neural network analysis • Regression analysis • And other approved methods by CMS. The system for risk identification shall be grounded in sound analytic methodologies and rely on algorithms informed by analytic, medical, clinical, and administrative knowledge that enables identification of improper payments before final payment is authorized by CMS. The system shall output analytic results and reports to CMS (or its Contractors) in a timely manner and in a format that provides flags back to CMS systems supporting the claims lifecycle before the claim is adjudicated. The Contractor shall tailor the system design, development, and implementation to deliver the highest probability of successful outcomes in the stipulated schedule for performance. The FPS2 shall have increase capabilities from the FPS1 as follows: • Decrease model time to market and eliminate recoding of models to custom language • Expand toolset to include social network analysis visualization • Improve user interface based on previous on past usability studies • Improve model management and visibility and evaluation of prioritization rules • Business Intelligence Reporting Tools (Dashboard) connect to the live FPS2 system and allows drill-down capabilities to claims level • Create a mirrored testing environment to allow testing of how a new model will interact with existing models (e.g. how new models impact workload) FPS2 shall be a standalone system not built on the foundations of the current FPS1. The Contractor shall be responsible for the entire FPS2 system life cycle from requirements, design, development, integration, acceptance testing, deployment, training, and production support to subsequent system enhancements. The Contractor shall develop the FPS2 system to meet the requirements and specifications of this SOW following applicable CMS IT standards, including CMS Technical Reference Architecture ("TRA"), CMS Information Security ("IS") Acceptable Risk Safeguards ("ARS"), and the CMS Expedited Life Cycle ("XLC") process identified in the SOW Reference Documents. The FPS2 system shall employ market-leading technologies. CMS expects the system will require customization, configuration, and potential integration of Commercial Off-the-Shelf ("COTS")-based products to perform access management, workflow processing, database management, document management, reporting, and allow for data exchange and integration with other CMS systems. While the implemented FPS2 system may consist of multiple COTS products, this shall be transparent to users; the look and feel of the user interface will represent a common product interface and use single-sign-on ("SSO") between products. The Contractor shall support users during the initial transition to the new FPS2 system and deliver ongoing user support when the system is operational. A DRAFT Statement of Work (SOW) and deliverable schedule are attached for reference ONLY. The FINAL SOW and deliverable schedule will be issued with the solicitation. CMS intends to award a Cost-Plus-Award-Fee contract to the successful offeror. The anticipated period of performance is one (1) twelve (12) month base period and four (4) twelve (12) month option periods. The solicitation will be available on the FBO website. It is anticipated that the contract will be awarded in October 2015. Any questions regarding this synopsis should be directed to Donald Bozimski, Contract Specialist, via email at donald.bozimski@cms.hhs.gov, and Tonya D. Anderson, Contracting Officer, via email at tonya.anderson@cms.hhs.gov.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/CMS-150097/listing.html)
- Record
- SN03707246-W 20150424/150422234654-9436d4ffd00101b9a5b47dfc7a3d4f10 (fbodaily.com)
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