Our Contracts

StrategicHealthSolutions, LLC (Strategic) works with Federal health care agencies to take a stand against fraud, waste, and abuse (FWA) in the Medicare and Medicaid Programs. To support these efforts, Strategic pursues contracts that range in scope from education and training to review and analysis. If you require information about the availability of auxiliary aids and services for CMS materials, please visit: https://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.

Click the links below to better understand how Strategic’s current contract work benefits the health care programs, beneficiaries, and U.S. taxpayers.

Supplemental Medical Review Contractor

Strategic is a centralized resource to perform medical review on a large volume of Medicare Part A, Part B, and Durable Medical Equipment (DME) reimbursement claims nationally

Conduct Part D Formulary and Benefits Review

Strategic reviews Medicare Part D Plan formularies and benefits as the Conduct Part D Formulary and Benefits Review contractor

Department of Justice Litigative Consultant

Strategic serves as the litigative consultant for contracts with the U.S. Department of Justice (DOJ) and Office of Inspector General (OIG).

MLN Product Development and Quality Assurance Program

Strategic designs, develops, and produces plain language educational materials for the Medicare Learning Network® (MLN) as the MLN Product Development and Quality Assurance Program (MLN PDQ) contractor.

Medicare Part C and Part D Program Integrity Technical Assistance

Strategic provides overall national support for the analysis of Medicare Parts C and D program integrity initiatives.

Medicare Secondary Payer Integration Contractor

Strategic ensures all components that support the COB&R contract function together and that all new and ongoing activities are properly communicated, handled, and managed by the COB&R contractors.

Quality of Care Monitor

Strategic is the Quality of Care Monitor for two Corporate Integrity Agreements (CIAs). We are responsible for evaluating the effectiveness of a company’s internal quality control systems, its response to quality of care issues, and its compliance with the quality of care provisions of the OIG’s CIA.

Risk Adjustment Data Validation Intake Medical Record Review Contractor

Strategic is the Risk Adjustment Data Validation (RADV) Intake Medical Record Review Contractor (IMRRC). We conduct independent medical record reviews to evaluate the accuracy of diagnosis data submitted for Medicare Part C payment by Medicare Advantage (MA) organizations.

Risk Assessment Performance and Analysis Technical Assistance

Strategic supports the Centers for Medicare & Medicaid Services’ (CMS) Core Program Integrity Team’s efforts to execute the U.S. Department of Health and Human Services’ (HHS) Program Integrity Initiative to ensure program integrity and maintain responsible stewardship of funds across all HHS programs, including Medicare and Medicaid.