Lumetra v. United States

84 Fed. Cl. 542, 2008 U.S. Claims LEXIS 328, 2008 WL 4967981
CourtUnited States Court of Federal Claims
DecidedNovember 14, 2008
DocketNo. 08-663C
StatusPublished
Cited by13 cases

This text of 84 Fed. Cl. 542 (Lumetra 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
Lumetra v. United States, 84 Fed. Cl. 542, 2008 U.S. Claims LEXIS 328, 2008 WL 4967981 (uscfc 2008).

Opinion

OPINION AND ORDER1

LETTOW, Judge.

This is a post-award bid protest. Lumetra challenges the award of a contract to perform work as the California Medicare Quality Improvement Organization (“QIO”). This contract was awarded to Health Services Advisory Group, Inc. (“HSAG”) by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (“CMS”). Lumetra, the incumbent contractor, contends that CMS improperly evaluated Lumetra’s and HSAG’s proposals with respect to the issues of past performance, personnel, governance, cost, and cost-realism, and further alleges that the prospee-five contractors were provided materially different access to agency information. See Compl. If 3.

Lumetra has submitted a motion for judgment on the administrative record, seeking a preliminary and permanent injunction requiring CMS to terminate the contract with HSAG and award the contract to Lumetra. See Pl.’s Mem. in Support of Mot. for a Permanent Injunction and Judgment on the Administrative Record (“Pl.’s Mot.”). In the alternative, Lumetra seeks an injunction requiring CMS to conduct a re-evaluation of the proposals and make a new best value determination, cost-technical tradeoff, and award decision. The United States has responded by submitting a cross-motion for judgment on the administrative record, contending that CMS properly evaluated Lume-tra’s and HSAG’s proposals. See Def.’s Opp’n to Pl.’s Mot. for a Permanent Injunction and Judgment on the Administrative Record and Def.’s Cross-Motion for Judgment on the Administrative Record (“Def.’s Cross-Mot.”). In addition, Lumetra has submitted a motion for supplementation of the administrative record, requesting the inclusion of seventeen additional documents. A hearing on the competing motions was held on October 16, 2008, and the motions accordingly are ready for disposition.

FACTS2

A Statutory Scheme

Congress established the Medicare program in 1965 by enacting Title XVIII of the Social Security Act, thereby creating a federally funded program that provides health [545]*545insurance to various eligible beneficiaries including the elderly and the disabled. See Health Insurance for the Aged Act, Pub.L. No. 89-97, § 102(a), 79 Stat. 286 (1965) (codified as amended in 42 U.S.C. §§ 1395-1396d and scattered sections of titles 26, 42, and 45 of the United States Code); Telecare Corp. v. Leavitt, 409 F.3d 1345, 1346 (Fed.Cir.2005). The Medicare program is administered by CMS, a unit within the Department of Health and Human Services. See Wilson v. United States, 405 F.3d 1002, 1005 (Fed.Cir.2005) (citation omitted).

To “promote the effective, efficient, and economical delivery of health care services,” Congress amended Part B of Title XI of the Social Security Act by passing the Peer Review Improvement Act of 1982, Pub.L. No. 97-248, 96 Stat. 381, §§ 141, 142 (Sept. 3, 1982) (codified as amended at sections included within 42 U.S.C. §§ 1320c-1396b), which authorized the Medicare Utilization and Quality Control Peer Review Organization Program (“the QIO Program”). The statutory mission of a QIO is to “perform a wide variety of quality improvement interventions and provide technical assistance to providers to improve the quality of care furnished to Medicare beneficiaries.” AR 90A-4916 (Statement of the Contracting Officer, Brian Hebbel).3 The QIO Program requires CMS to enter into a contract with a private organization typically composed of licensed physicians whenever it seeks (1) to determine whether Medicare services are reasonable and necessary, (2) to promote “effective, efficient, and economical delivery of Medicare services,” or (3) “to promot[e] the quality” of the services funded by Medicare. 42 U.S.C. § 1395y(g); see Public Citizen, Inc. v. Dep’t of Health & Human Servs., 151 F.Supp.2d 64, 67 (D.D.C.2001).

Overall, the QIO Program embraces 53 separate performance-based cost reimbursement contracts between CMS and QIOs—one for each state, territory, and the District of Columbia. See AR 90-A-4916 (Statement of the Contracting Officer); AR 111-5246 (CMS Justification Memorandum for Override of Automatic Stay Pending Protest of Lumetra, Government Accountability Office Protest, B-400456 (Sept. 5, 2008)). The term of a QIO is three years in length; each three-year term is guided by a Statement of Work (“SOW”). See AR 90A-4917 (Statement of the Contracting Officer). The contract may be renewed on a triennial basis, as long as the state QIO contractor satisfies various performance standards. 42 U.S.C. §§ 1320c-2(c)(2)-(3), (e)(7). If CMS makes a determination that a QIO has performed unsatisfactorily in a particular state, CMS may initiate a new competitive process to award a contract for QIO services in that state. 42 U.S.C. §§ 1320e-2(c)(4), (i)(2).

B. Lumetra’s Failure to Fulfill All Required Elements of its Prior Contract

For the first eight contracting cycles, from 1984 to 2008, Lumetra was the incumbent QIO contractor for the State of California. Pl.’s Mot. at 3. The ninth cycle and SOW was scheduled to begin in all states on August 1, 2008. AR 90A-4917 (Statement of the Contracting Officer). The ninth SOW differed from the eighth SOW insofar as it was explicitly structured around a variety of mandatory and optional “themes” relating to different quality improvement areas. See id. Three core themes under the new SOW dealt with Beneficiary Protection (Theme 6. 1), Patient Safety (Theme 6.2), and Prevention (Theme 6.3). AR 10B1817 (RFP No. CMS-2007QI09thSOW-NAHC Amended Sections L and M) (“RFP Sections L and M”).

After evaluating Lumetra’s performance under the eighth SOW, CMS notified Lume-tra that it had failed to satisfy the standard of performance necessary to trigger automatic renewal for the ninth SOW contract for California. AR 11-2157 (Performance Evaluation 8th SOW (Oct. 20, 2007)).4 CMS spe-[546]*546cificaUy assigned Lumetra a rating of “Not Pass” on the performance objective of Physician Practice, labeled Task ldl. Id; Hr’g Tr. 77:13-17.5 CMS also notified Lumetra that it would be opening the California QIO contract to re-competition. AR 11-2157 (Performance Evaluation 8th SOW).

Exercising the statutory right set forth in 42 U.S.C. § 1320c-2(c)(4),6 Lumetra challenged CMS’ evaluation of Task ldl and submitted additional data regarding its performance under the eighth SOW. AR 15-2229 (Lumetra Performance Evaluation Letter); Hr’g Tr. 80:15-17. A panel of CMS members re-assessed Lumetra’s performance and recommended that CMS’ initial finding of Lumetra’s “Not Pass” rating on Task ldl be upheld. AR 15-2229 (Lumetra Performance Evaluation Letter).

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Bluebook (online)
84 Fed. Cl. 542, 2008 U.S. Claims LEXIS 328, 2008 WL 4967981, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lumetra-v-united-states-uscfc-2008.