Cgi Federal Inc. v. United States

118 Fed. Cl. 337, 2014 U.S. Claims LEXIS 842, 2014 WL 4179360
CourtUnited States Court of Federal Claims
DecidedAugust 22, 2014
Docket1:14-cv-00355
StatusPublished
Cited by4 cases

This text of 118 Fed. Cl. 337 (Cgi Federal Inc. v. United States) is published on Counsel Stack Legal Research, covering United States Court of Federal Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cgi Federal Inc. v. United States, 118 Fed. Cl. 337, 2014 U.S. Claims LEXIS 842, 2014 WL 4179360 (uscfc 2014).

Opinion

*340 Pre-award Bid Protest; 28 U.S.C. § 1491(b)(1); Jurisdiction; Standing; Prospective Bidder; Direct Economic Interest In Award; Centers for Medicare and Medicaid Services (“CMS”); Federal Acquisition Regulation (“FAR”) Part 12; FAR Subpart 8.4; Federal Acquisition Streamlining Act (“FASA”); Customary Commercial Practice; Payment Term; Unduly Restrictive of Competition.

OPINION AND ORDER

WILLIAMS, Judge.

This pre-award bid protest comes before the Court on Defendant’s motion to dismiss for lack of standing, Plaintiffs motion for injunctive relief, and the parties’ cross-motions for judgment on the Administrative Record (“AR”). Plaintiff, CGI Federal Inc. (“CGI”), challenges the payment terms of three Requests for Quotation (“RFQ”) issued by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (“CMS”) for services of Recovery Audit Contractors (“RACs”) under the General Services Administration’s (“GSA”) Federal Supply Schedule (“FSS”). 2

Plaintiff argues that CMS violated the Federal Acquisition Streamlining Act (“FASA”) and Part 12 of the Federal Acquisition Regulation (“FAR”) by including payment terms in the RFQs that are inconsistent with customary commercial practice. Plaintiff further claims that the payment terms are unduly restrictive of competition. Accordingly, CGI asks this Court to enjoin award of the contracts under these RFQs, order CMS to revise the existing payment terms, and provide all prospective bidders an opportunity to submit bids under the revised RFQs.

Defendant argues that the requirements of FASA and FAR Part 12 do not apply to FAR Subpart 8.4 FSS procurements, and that the payment terms do not unduly restrict competition, pointing to other RACs that bid on the contested RFQs. Finally, Defendant submits that CMS reasonably exercised its discretion even if the payment terms restrict competition.

For the reasons that follow, the Court finds that Plaintiff has standing, but denies the protest.

Findings of Fact 3

The Medicare Fee-for-Service Recovery Audit Program

CMS administers the Medicare Fee-for-Services (“FFS”) program and, through a network of contractors, processes more than one billion claims each year submitted by more than one million providers. AR Tab 20f at 533. 4 To insure that paid claims accord with Medicare guidelines, CMS uses Recovery Audit Contractors to identify improper payments and highlight any common billing errors, trends, or other Medicare payment issues. Id. After a pilot program, CMS competitively awarded contracts in 2008 to four RACs — one for each geographical region of the country — including CGI, but performance was delayed due to a bid protest. AR Tab 20f at 533; AR Tab 95 at 8608-10. 5

The RAC program has successfully assisted CMS in recouping improper Medicare payments. In the 2011 fiscal year alone, RACs identified 887,291 improper payments, resulting in corrections totaling $939.3 million. AR Tab 20f at 533. “After taking into consideration all fees, costs, and appeals, the Medicare FFS Recovery Audit Program re *341 turned $488.2 million to the Medicare Trust Fund” in 2011. Id. That same year, providers appealed 6.7% of identified overpay-ments, but less than half of that 6.7% were successful at some level of the appeal process. Id. at 667.

Each RAC reviews the Medicare FFS claim payments processed in its region to identify improper payments. 6 CMS pays the RACs on a contingency fee basis calculated as a percentage of the improper payment. AR Tab 20f at 537. When a RAC identifies an improper payment, CMS, through a contractor, sends the provider a demand letter that in the ease of an overpayment requests repayment in a specific amount. Id. at 538. The demand letter also contains the rationale provided by the RAC “including] references utilized in reviewing the medical documents, and ... educating] providers about how to avoid similar payment errors in future Medicare billing practices.” Id. 7 CMS’ recoupment of an overpayment typically commences within 41 days of the demand letter. Id. at 539.

The Appeal Process

If a provider disagrees with the RAC’s determination that CMS overpaid the provider, the provider can appeal. There are five levels of appeal. See id. at 539.

The First Level of Appeal: “Redetermination”

After receiving a demand letter that identified an overpayment, regardless of the amount in controversy, a provider can appeal by seeking a redetermination as to the propriety of the identified payment. Id. at 539-40; see also 42 C.F.R §§ 405.940-42. This “first level appeal” must be requested, in writing, within 120 days of receiving the demand letter. 42 C.F.R §§ 405.942(a), 405.944(b). The provider must explain the basis for its disagreement with the determination and may submit any relevant evidence. Id. at § 405.946(a). A written decision will be rendered within 60 days of receipt of the provider’s request for a redetermination and must inform the provider of its right to appeal and the procedures for seeking a redetermination. Id. at §§ 405.950(a), 405.956(b)(5).

The Second Level of Appeal: “Reconsideration at the QIC Level”

If a provider disagrees with the redetermi-nation, it can appeal to a qualified independent contractor (“QIC”) within 180 days of its receipt of the redetermination letter. AR Tab 20f at 539; 42 C.F.R § 405.962(a). In CMS parlance, this level of appeal is referred to as “reconsideration,” “the QIC level,” and “the second level” interchangeably. The QIC reviews the evidence and findings upon which the initial determination and the rede-termination were based, as well as any additional evidence a provider submits or that the QIC obtains independently. 42 C.F.R. § 405.968(a)(1). QICs must process the provider’s appeal within 60 days. Id. at § 405.970(a).

The Third Level of Appeal: A Hearing Before An Administrative Law Judge (“ALJ”)

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Cite This Page — Counsel Stack

Bluebook (online)
118 Fed. Cl. 337, 2014 U.S. Claims LEXIS 842, 2014 WL 4179360, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cgi-federal-inc-v-united-states-uscfc-2014.