Cigna Government Services, LLC v. United States

70 Fed. Cl. 100, 2006 U.S. Claims LEXIS 66, 2006 WL 710968
CourtUnited States Court of Federal Claims
DecidedMarch 3, 2006
DocketNo. 06-108C
StatusPublished
Cited by16 cases

This text of 70 Fed. Cl. 100 (Cigna Government Services, LLC 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
Cigna Government Services, LLC v. United States, 70 Fed. Cl. 100, 2006 U.S. Claims LEXIS 66, 2006 WL 710968 (uscfc 2006).

Opinion

OPINION AND ORDER GRANTING A DECLARATORY JUDGMENT

WILLIAMS, Judge.

In this post-award bid protest, Plaintiff CIGNA Government Services, LLC (Cigna), challenges an override decision issued by the Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) in a pending protest at the Government Accountability Office (GAO). This action arises out of CMS’ procurement for Medicare claims administration services covering durable medical equipment, prosthet-ics, orthoties, and supplies (DMEPOS)—the first in a series of procurements conducted under the Medicare Prescription Drug Improvement Modernization Act of 2003, Pub.L. 108-173(MMA) requiring competitive contracting procedures and compliance with the Federal Acquisition Regulation (FAR) to re[101]*101place existing contracts which had not been subject to the requirements of full and open competition. The solicited services include processing and paying DMEPOS claims, handling first-level appeals of denied claims, and serving as the primary contact with CMS for providers. The solicitation included four separate geographic jurisdictions for award designated as A, B, C and D. At issue here are the awards in Jurisdictions C and D.

Under the Competition in Contracting Act (CICA), Cigna’s timely protest to GAO of contract awards to Noridian Administrative Services, LLC (Noridian) and Palmetto GBA, LLC (Palmetto) triggered an automatic stay of these awards for 100 days to enable GAO to resolve the protest and provide meaningful relief in the event the protest is sustained. The agency decision challenged here overrode the stay on the ground that continued performance is in the best interests of the United States—immediately enabling the awardees to begin performing the contracts. Such performance is ongoing. This matter comes before the Court on Plaintiffs request for a declaratory judgment invalidating the override and motion for a permanent injunction—both of which would effectively reinstate the stay.

The essence of the override decision is that the stay would delay CMS’ scheduled implementation of a newer and better Medicare claims processing system—a massive undertaking—preventing the Government from reaping the cost savings and enhanced performance under the new contracts.2 The problem with this delay-based justification is that CMS, in a report to Congress in February 2005, asserted that it had “flexibility” in its procurement schedule which could accommodate “any unforseen changes in the marketplace or legislative environment” and still enable CMS to meet the Congressionally-mandated implementation date of 2011 for the new contracts. CMS’ asserted need to maintain its “tight schedule” which underlies this override directly contradicts its self-proclaimed schedule flexibility in its report to Congress.3

CMS’ override also failed to consider several relevant factors. CMS summarily concluded, without explanation or backup, that “the potential harm to Medicare program in delaying implementation of the Durable Medical Equipment Medicare Administrative Contractors (DME MAC) contracts outweighs the risk that GAO will require corrective action as a result of the Cigna protest.” The override decision did not articulate the risks to the Medicare contracts in the event GAO should sustain the protest. The decision did not mention the costs associated with undoing the transition work if GAO orders a recompetition—costs of terminating the new contracts and potentially retransi-tioning different contractors. Nor did the override evidence any consideration of the minimal harms to the agency in the event GAO denies the protest and the stay remains in place. There has been no showing that a 70-day hold on the procurements will have any adverse impact on the receipt of Medicare claims processing services during the stay. This work will continue to be performed under the incumbent contracts which are in effect until September 2006 and are renewable.

CMS’ override decision determined that proceeding with the awards until GAO decides the protest would not take work away from Cigna. However, potential loss of work is not the only harm to Cigna here—the [102]*102override ignores the competitive advantage that awardees could gain in the event of a recompetition by performing the new contract now. Cigna’s proposal had received [ ] in both Jurisdictions C and D, and one technical evaluation factor for award in the Solicitation, the most important, “capability,” assesses an offeror’s “understanding of requirements.” Clearly, there is a risk that a contractor would gain an “understanding of requirements” by performing them. In addition, the transition from Cigna to Noridian in Jurisdiction D involves a transfer of Cigna’s processes and methodologies to Noridian now, which, in the absence of a stay, poses a risk of an unfair competitive advantage to Noridian should GAO order a recompetition.4

Nor did the override decision consider the statutory mandates for competition in both CICA and the MMA and the adverse impact on competition that the override could effect. It is ironic that CMS, in overriding the stay, is undermining a key component of the competitive procurement process it is supposed to be furthering under the MMA, by taking some of the teeth out of the GAO protest process.5 Finally, the record does not support a determination in the override that there would be some $5 million in savings realized by going forward with the contracts.

Because the override decision contradicts evidence of record regarding the impact of delay, fails to consider relevant factors or to explain its conclusion and is not supported by the AR, the Court declares the override decision invalid and sets it aside, thereby reinstating the stay in Cigna’s GAO protest.

Findings of Fact6

Cigna is a Part B Medicare Carrier for Idaho, North Carolina and Tennessee, and the incumbent DME Regional Contractor (DMERC) for CMS Region D.7 Cigna has served as the incumbent Jurisdiction D DMERC contractor for the past 13 years. Cigna and the other three DMERCs currently process DMEPOS claims for the Medicare program and will continue to do so until the transition under the challenged procurement is completed.

Noridian, the contract awardee for the Jurisdiction D DME MAC contract, is headquartered in Fargo, North Dakota, is not an incumbent DMERC, and has not processed DMEPOS claims previously. Palmetto, the contract awardee for the Jurisdiction C DME MAC contract, is headquartered in Columbia, South Carolina and currently serves as the DMERC for the majority of the states in Jurisdiction C except for Virginia and West Virginia, which AdminaStar Federal, Inc., another DMERC, currently services.8

[103]*103The Medicare Program provides health insurance to (1) eligible individuals aged 65 and over; (2) certain individuals eligible for disability benefits under the Social Security System and their dependents; and (3) individuals with acute kidney failure. SOW at 11; PL’s TRO Ex. 1. Medicare covered approximately 43 million people in FY 2003. Id. The majority of Medicare beneficiaries access their insurance benefits in the traditional Medicare fee-for-service (FFS) program, under which CMS provides the benefits through an indemnity insurance model. Id.

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Cite This Page — Counsel Stack

Bluebook (online)
70 Fed. Cl. 100, 2006 U.S. Claims LEXIS 66, 2006 WL 710968, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cigna-government-services-llc-v-united-states-uscfc-2006.