Aclr, LLC v. United States

Court of Appeals for the Federal Circuit·Decided September 27, 2024·No. 23-1190·Unpublished

Opinion

NOTE: This disposition is nonprecedential.

United States Court of Appeals for the Federal Circuit

ACLR, LLC, Plaintiff-Appellant

v.

UNITED STATES, Defendant-Appellee

2023-1190

Appeal from the United States Court of Federal Claims in No. 1:15-cv-00767-PEC, Judge Patricia E. Campbell- Smith.

Decided: September 27, 2024

JOHN BONELLO, Reston Law Group LLP, Reston, VA, argued for plaintiff-appellant. Also represented by THOMAS DAVID.

JOSEPH ALAN PIXLEY, Commercial Litigation Branch, Civil Division, United States Department of Justice, Washington , DC, argued for defendant-appellee. Also represented by BRIAN M. BOYNTON, AUGUSTUS JEFFREY GOLDEN, MARTIN F. HOCKEY, JR., PATRICIA M. MCCARTHY.

2 ACLR, LLC v. US

Before PROST, HUGHES, and STARK, Circuit Judges.

STARK, Circuit Judge.

ACLR, LLC (“ACLR”) appeals from the United States Court of Federal Claims’ grant of summary judgment to the government on ACLR’s claims for breach of contract, breach of the implied covenant of good faith and fair dealing , and recovery of certain termination-for-convenience damages. We affirm.

I

A

Medicare Part D is a voluntary outpatient prescription drug reimbursement program that went into effect on January 1, 2006. Under the program, prescription plan sponsors , such as private insurance providers, pay for prescription drugs for their beneficiaries and then receive reimbursements from the government. Specifically, the Centers for Medicare & Medicaid Services (“CMS”) makes monthly prospective payments to insurance providers and then, at the end of each year, reconciles those payments with the insurers’ actual costs, to ensure that the government has not overpaid (e.g., by making duplicate payments ).

ACLR is a management consulting company that offers recovery auditing services. On June 17, 2010, ACLR entered into a federal supply schedule contract with the General Services Administration (“GSA”), which made ACLR eligible to offer recovery auditing services to government agencies. Relevant to this appeal, the GSA contract included Federal Acquisition Regulation (“FAR”) 52.212-4(l), which expressly permits an ordering agency, i.e., an agency contracting ACLR’s services, such as CMS, to “terminate [a] contract or any part [t]hereof, for its sole convenience.” J.A. 4624; see also 48 C.F.R. § 52.212-4(l). This “termination for convenience” provision further sets out the

ACLR, LLC v. US 3

damages a terminated contractor, such as ACLR, could attempt to recover. It provides that if an ordering agency elects to terminate the contract for convenience, the contractor is entitled to “a percentage of the contract price reflecting the percentage of the work performed prior to the notice of termination, plus reasonable charges the Contractor can demonstrate[,] to the satisfaction of the ordering [agency] using its standard record keeping system, have resulted from the termination.” J.A. 4624; see also 48 C.F.R. § 52.212-4(l).

On December 2, 2010, CMS issued a Request for Quote (“RFQ”), inviting proposals for an award of a contingency fee task order for recovery audit contractor (“RAC”) services in support of the Medicare Part D program. The RFQ specifically advised potential bidders that, consistent with the FAR provision in the GSA contract, the “Government may . . . terminate for convenience if it deems such termination to be in the best interest of the Government.” J.A. 1941. ACLR submitted a proposal. On January 13, 2011, CMS awarded a task order to ACLR, by which ACLR agreed to identify and seek to recover overpayments CMS had made to private insurers under the Medicare Part D program. The task order incorporated the GSA contract by reference, thereby also incorporating the FAR 52.212-4(l) termination for convenience provision. As the parties do, we henceforth refer to the contract between ACLR and CMS, which includes the provisions of the task order and GSA contract, as the “Part D RAC Contract.”

Initially, the task order required that ACLR “perform the work required in accordance with the attached performance work statement (PWS).” J.A. 1174. The PWS did not explicitly require CMS approval for the steps ACLR would take to conduct its audits. Moreover, ACLR had prepared and submitted the PWS along with its proposal, and CMS provided no input regarding the PWS at the time it awarded the task order to ACLR. Therefore, the 2007 audit , which was governed by the terms of the Part D RAC 4 ACLR, LLC v. US

Contract – including the task order and the PWS – could potentially be conducted in a manner never approved by CMS.

Subsequent events led the parties to spend approximately two years negotiating a Statement of Work (“SOW”) that would replace the PWS. On December 31, 2013, ACLR and CMS agreed to eliminate the PWS and substitute in its place the SOW, which explicitly required CMS approval for audits to be conducted by ACLR. The 2010 audit was governed by the terms of the Part D RAC Contract, including the task order and the SOW.

With respect to ACLR’s compensation, the task order was explicit that payments to ACLR would be dependent on what ACLR collected on behalf of CMS, providing:

All payments shall be paid only on a contingency basis. The recovery audit contractor will receive 7.5% of all amounts collected. The contingency fees shall be paid once the recovery audit contractor collects the Medicare overpayments. . . . The recovery audit contractor shall not receive any payments for the identification of the underpayments or overpayments not recovered/collected.

J.A. 1175 (emphasis added).

ACLR performed work for CMS between 2011 and 2015, eventually conducting at least 20 audits. For seven of those audits, ACLR obtained all necessary approvals from CMS, collected monies from private insurers, and was then paid contingency fees for its work on these audits. The remaining thirteen ACLR audits were not approved by CMS. Two of these, relating to payments to insurers for the years 2007 and 2010, are the subject of this appeal.

B

CMS began transmitting the 2007 audit records to ACLR on November 17, 2011, and shortly thereafter ACLR

ACLR, LLC v. US 5

began reviewing those records. On November 30, 2011, during a conference call, ACLR informed CMS that it had already identified potential duplicate payments in the 2007 records and was ready to commence recovery of the improper payments. On that same call, the CMS Contracting Officer’s Technical Representative, Marnie Dorsey, told ACLR that the then-governing PWS was only a “proposal” and “hadn’t been approved per se.” J.A. 1301-05. The CMS Contracting Officer Desiree Wheeler then told ACLR “[t]o not issue demand letters” to private insurers, effectively terminating the 2007 audit. J.A. 1288; see also J.A. 2425 (ACLR report summarizing review of 2007 audit).

No duplicate payments were ever recovered as a result of the 2007 audit. Hence, CMS did not pay ACLR any contingency fees for this work. ACLR contends that, before CMS’s breach, it had identified $313,808,241 in potential duplicate payments and is entitled to be paid 7.5% of this amount as contingency fees, which comes to $23,535,616.

In January 2014, CMS authorized ACLR to undertake an audit of 2010 payments, consistent with the then-governing SOW. On June 9, 2014, ACLR provided CMS with its accounting of potential duplicate payments, and in December 2014 it submitted its final 2010 review package. CMS, working with a data validation contractor, found inaccuracies in ACLR’s submission and questioned its findings . After much back and forth, CMS terminated the 2010 audit by letter dated April 24, 2015, due to “concerns with the validity of the overall audit results.” J.A. 793.

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