National Government Services v. United States

923 F.3d 977
CourtCourt of Appeals for the Federal Circuit
DecidedMay 2, 2019
Docket2018-1927
StatusPublished
Cited by39 cases

This text of 923 F.3d 977 (National Government Services v. United States) is published on Counsel Stack Legal Research, covering Court of Appeals for the Federal Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
National Government Services v. United States, 923 F.3d 977 (Fed. Cir. 2019).

Opinion

Prost, Chief Judge.

*979 In this bid protest, National Government Services, Inc. ("NGS") appeals the decision of the Court of Federal Claims ("Claims Court") denying NGS's pre-award bid protest. Nat'l Gov't Servs., Inc. v. United States , 137 Fed.Cl. 715 (2018) (" Decision "). We reverse the decision of the Claims Court and remand for further proceedings.

I

The Centers for Medicare & Medicaid Services ("CMS") is an agency of the U.S. Department of Health and Human Services ("HHS"). CMS uses contractors to administer claims and benefits related to the Medicare program.

From the inception of Medicare in 1965 until implementation of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ("Medicare Modernization Act"), CMS procured contractors to administer Medicare claims and benefits through noncompetitive contracts. Decision , at 719. In the Medicare Modernization Act, however, Congress added Section 1874A to the Social Security Act (Title XVIII) to create the Medicare administrative contractor ("MAC") program. See Medicare Modernization Act, Pub. L. No. 108-173, § 911(a)(1), 117 Stat. 2066 , 2378-83 (codified as amended at 42 U.S.C. § 1395kk-1 ("the MAC Statute")).

The companies that process Medicare claims on behalf of CMS are called Medicare administrative contractors or MACs. See 42 U.S.C. § 1395kk-1(a)(3). An "A/B" MAC provides services with respect to Medicare Parts A and B. See 42 U.S.C. § 1395kk-1(a)(4) ; see also id. §§ 1395h(a), 1395u(a). The MAC Statute generally requires CMS to "use competitive procedures when entering into contracts with [M]edicare administrative contractors [MACs] under this section, taking into account performance quality as well as price and other factors." § 1395kk-1(b)(1)(A).

The nationwide MAC contract market is currently divided into twelve geographic jurisdictions: 5, 6, 8, and 15, plus E, F, H, and J-N. Decision , at 719-20. For example, Jurisdiction H represents 13.5% of the current A/B Medicare workload and covers Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas. Meanwhile, Jurisdiction 8 represents 5.9% of the current A/B Medicare workload and covers Indiana and Michigan. Decision , at 719-20. CMS solicits contracts for each jurisdiction.

A

In 2010, CMS began preparing for its second round of solicitations to replace the original A/B MAC contracts as they expired. 1 In July 2010, CMS issued a Request for Information ("RFI") that described *980 changes to CMS's approach to the A/B MAC procurements and provided an opportunity for potential offerors to give input on those changes. One of CMS's proposed changes was to implement a contract award limit for the A/B MAC contracts to be included in all A/B MAC solicitations. J.A. 11465 (RFI). The purpose of this award limit was "to place a limit, in all A/B MAC Round II solicitations, on the amount of A/B MAC contract responsibility that any single entity can win ... in a 'prime contractor' capacity." Decision , at 721-22 (quoting J.A. 11465 (RFI)).

In August 2010, CMS issued another RFI regarding this proposed award limitations policy ("Award Limitations Policy" or "Policy"). See J.A. 11472-82 (RFI). CMS indicated that this Policy would be included in all solicitations for the second round of MAC contracts. Decision , at 724 (citing J.A. 11478). After making some revisions to the Policy, CMS included the Policy in the Jurisdiction F solicitation, which CMS issued in October 2010. According to the Policy, CMS would not award more than 26% of the national A/B Medicare workload to any single contractor or more than 40% of the national A/B Medicare workload to any one set of affiliates. Decision , at 724-25 (quoting the Jurisdiction F solicitation).

CMS designed the Award Limitations Policy to address two market concerns: (1) "business continuity concerns with awarding an overly-large share of the Medicare claims administration workload to any one entity (or set of affiliated entities)"; and (2) "maintain[ing] a dynamic, competitive marketplace, where no single entity (or set of affiliated entities) control/s so much of the agency's MAC business that all or most other players are driven from the market, returning the agency to a less-than-competitive environment." J.A. 11801 ¶ 7 (Klots Decl.).

B

CMS continued to incorporate the Award Limitations Policy into solicitations for other jurisdictions, including Jurisdiction H ("JH"). See J.A. 15546-48. As stated in the JH solicitation, the Policy explains:

CMS will not award more than 26% of the national A/B Medicare workload, in A/B MAC prime contracts, to any single contractor (single corporate entity). In addition, CMS will not award more than 40% of the national A/B Medicare workload, in A/B MAC prime contracts, to any one (1) set of affiliates.
CMS is placing no limitation on the number of A/B MAC prime contracts for which any entity, or entities, may submit proposals. As A/B MAC prime contracts are awarded, the awardee's Medicare workload base will be appropriately adjusted, thereby potentially impacting other pending proposals.

J.A. 15546. 2 The workload percentages assigned to each MAC jurisdiction are included in the solicitation. J.A. 15548.

The JH solicitation explains that "CMS will determine whether Offerors exceed the limitation on workload at the time of award, and will exclude Offerors from consideration on such basis at that time." J.A. 15547. Moreover, the solicitation includes an "Exception," which states:

In order to ensure continuity in Medicare Fee-for-Service operations, CMS retains the discretion to award a particular A/B MAC prime contract to a particular contractor, even where doing so would otherwise exceed the A/B MAC prime contract Medicare workload allowed by this policy.

*981 J.A. 15548. We refer to this exception as the "Continuity Exception."

NGS is an offeror for the JH solicitation. 3

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Bluebook (online)
923 F.3d 977, Counsel Stack Legal Research, https://law.counselstack.com/opinion/national-government-services-v-united-states-cafc-2019.