B -- CALIFORNIA MEDICARE/MEDICAID DATA ANALYSIS CENTER

Notice Date

July 9, 2001

Contracting Office

Department of Health and Human Services, Health Care Financing Administration, Acquisition and Grants Group, 7500 Security Blvd. C2-21-15, Central Building, Baltimore, MD, 21244-1850

ZIP Code

21244-1850

Solicitation Number

Reference-Number-CLB-01-0001

Response Due

July 24, 2001

Point of Contact

Cathy Baldwin, Contract Specialist, Phone 410-786-5791, Fax 410-786-9922, Email CBaldwin@hcfa.gov -- Leisa Bodway, Contracting Officer, Phone 410-786-1278, Fax 410-786-9922, Email LBodway@hcfa.gov

Description

The Centers for Medicare and Medicaid Services (CMS) has increased its efforts to use advanced technology to detect and prevent fraud and abuse and to endure that CMS pays the right provider the right amount for the right service, on behalf of the right beneficiary. Combining claims data from two major payers for health care services, Medicare and Medicaid, to search for aberrancies indicative of fraud and abuse should increase the likelihood of detecting activity that may fall below the detection threshold in either program individually. Reasons for this include the fact that many providers serve both the Medicare and Medicaid-eligible populations, and that there are a large number of beneficiaries eligible for both Medicare and Medicaid benefits. CMS intends to contract with National Heritage Insurance Corporation (NHIC), on a sole source basis for a base year and four one-year options, to conduct data matching and associated fraud and abuse review activities, utilizing data it presently warehouses from both the Medicare and Medicaid programs operating in the state of California. NHIC is in the unique position of serving as the Medicare Carrier for the state of California, while its parent corporation, Electronic Data Services (EDS), serves as that state?s Medicaid fiscal agent. In this position, NHIC and EDS have several years worth of claims records for both programs already loaded, in the same record layout format, in secure data warehouses. This announcement is not a request for proposals. However, if you believe that your organization possesses the unique capabilities to perform the data match in the state of California and CMS should not contract NHIC, please submit the appropriate information to substantiate such a claim. All correspondence in reference to this synopsis should be sent electronically to Cathy L. Baldwin, Contract Specialist, at cbaldwin@cms.hhs.gov.

Web Link

Visit this URL for the latest information about this (http://www.eps.gov/spg/HHS/HCFA/AGG/Reference-Number-CLB-01-0001/li sting.html)

Record

Loren Data Corp. 20010711/BSOL005.HTM (D-190 SN50R2A1)