Nebraska Department of Health and Human Services

Buyer seeks a qualified vendor to provide a Program Integrity Case Management (PICM) and Fraud Abuse Detection (FAD) Analytics solution. The solution will help detect, investigate, and prevent fraud, waste, and abuse in Medicaid programs. Buyer requires a comprehensive system with secure data management, robust analytics, and compliance with federal standards. The contract term will be five years with options to renew for two additional two-year periods.

• 6/10/2025 - Last day to submit written questions
• 6/25/2025 - State responds to written questions
• 7/10/2025 - Proposal Due Date
• 9/1/2025 - Vendor Demonstrations
• 10/1/2025 - Notification of Intent to Award
• 12/26/2025 - Contract award
• 1/2/2026 - Vendor start date

• Implement Program Integrity Case Management system for Medicaid fraud detection
• Develop Fraud Abuse Detection Analytics solution with algorithm library
• Provide data encryption and role-based access control
• Create audit trails for system activities
• Integrate with existing Medicaid Management Information Systems
• Support investigation of suspicious billing patterns
• Deliver fraud detection algorithms and statistical models
• Establish uptime standards and service level agreements
• Implement business continuity and disaster recovery plans
• Comply with CMS Conditions for Enhanced Funding