Description
The State of Maryland Department of Health seeks a qualified vendor to serve as the Medicaid Hospital Claims Audit Contractor (Recovery Audit Contract). The contractor will audit Medicaid hospital claims to identify overpayments and underpayments, recover improper payments, and provide recommendations to prevent future errors. Compensation is a contingency fee of 10% of the dollars recovered from overpayments (and a similar rate for underpayments). The contract is an indefinite‑quantity, fixed‑price award with a base term of three years starting August 1 2027, plus two optional one‑year extensions. The award is limited to certified small businesses (SBR) with MBE (14%) and VSBE (2%) participation goals. Key responsibilities include data mining, algorithmic sampling, provider portal development, monthly and emergency meetings, weekly calls, and detailed reporting. The contractor must have at least three years recent experience auditing hospital claims for Medicaid/Medicare, no conflicts of interest, and must comply with HIPAA, MBE/V SBE goals, and state/federal regulations.
• Scope: audit Medicaid hospital claims (general in‑state, out‑of‑state, and psychiatric hospitals) for over/under‑payments.
• Deliverables: recovery of improper payments, audit reports, provider portal, monthly/quarterly meetings, special reports as needed.
• Timeline: proposals due Nov 20 2026; contract starts Aug 1 2027; base term 3 years (options up to 5 years).
• Compensation: 10% of recovered amounts (estimated $30 M overpayments annually → ~$3 M potential fee).
• Eligibility: Small Business Reserve, MBE 14%, VSBE 2%.