Pgba, LLC v. United States, and Wisconsin Physicians Service Insurance Corporation

389 F.3d 1219, 2004 U.S. App. LEXIS 24268
CourtCourt of Appeals for the Federal Circuit
DecidedNovember 22, 2004
Docket19-126
StatusPublished
Cited by516 cases

This text of 389 F.3d 1219 (Pgba, LLC v. United States, and Wisconsin Physicians Service Insurance Corporation) 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
Pgba, LLC v. United States, and Wisconsin Physicians Service Insurance Corporation, 389 F.3d 1219, 2004 U.S. App. LEXIS 24268 (Fed. Cir. 2004).

Opinion

SCHALL, Circuit Judge.

This is a post-award bid protest case. On September 6, 2002, the Department of Defense, Military Health Care System, TRICARE Management Activity (“TMA”), issued a request for proposals (“RFP”) for a contract for the handling of claims processing for certain beneficiaries under a military health care benefits program known as “TRICARE.” Plaintiff-Appellant PGBA, LLC (“PGBA”), submitted a proposal in response to the RFP, as did Wisconsin Physicians Service Insurance Corporation (“WPS”). On July 25, 2003, TMA awarded the contract to WPS. After unsuccessfully challenging the award before the General Accounting Office (“GAO”), PGBA filed suit in the United States Court of Federal Claims seeking to have the award of the contract to WPS set aside. WPS entered the suit as intervening defendant.

In due course, the parties cross-moved for summary judgment on the administrative record. On March 31, 2004, the Court of Federal Claims granted-in-part and denied-in-part PGBA’s motion. Although the court found that TMA had committed errors that materially affected the bidding process adversely to PGBA, it declined to set aside award of the TRICARE contract to WPS. It did, however, rule that PGBA was entitled to recover its reasonable bid *1221 preparation and proposal costs. PGBA, LLC v. United States, 60 Fed.Cl. 196 (2004) (“Initial Decision”). Subsequently, on May 12, 2004, the court denied PGBA’s second motion for reconsideration. 1 PGBA LLC v. United States, 60 Fed.Cl. 567 (2004) (“Final Decision”). This appeal by PGBA followed. Because we conclude that the decision of the Court of Federal Claims does not represent an abuse of discretion, we affirm.

BACKGROUND

I.

TRICARE is a military health care benefits program that provides health care benefits to dependents of active duty service members and to retired service members and their dependents. TRICARE is administered within the Department of Defense by TMA. Until recently, the TRI-CARE system was divided into eleven geographical regions. TMA administered the eleven regions through seven Managed Care Support (“MCS”) contracts with prime contractors. The prime contractors, in turn, outsourced the claims processing through subcontracts with one of two private companies, PGBA or WPS. PGBA processed claims under five contracts for nine regions, while WPS processed claims under two contracts for the remaining two regions. Initial Decision, 60 Fed.Cl. at 198.

In October of 2000, Congress enacted legislation known as “TRICARE for Life.” Pub. L. No. 106-898, Div. A, Title VII, § 712, 114 Stat. 1654A-176 (2000). The legislation addressed a problem confronting individuals qualifying for both TRI-CARE and Medicare benefits — individuals known as “dual eligible beneficiaries.” Namely, prior to the enactment of TRI-CARE for Life, beneficiaries lost their coverage under TRICARE upon becoming eligible for Medicare. TRICARE for Life remedies this problem by making Medicare the primary payer and TRICARE the secondary payer for dual eligible beneficiaries. As secondary payer, TRICARE reimburses that portion of a health benefits claim not covered by Medicare. Passage of TRICARE for Life forced TMA to address the processing of the new dual eligible beneficiary claims. TMA did this by modifying the MCS prime contracts. The prime contractors in turn modified their subcontracts with PGBA and WPS. Initial Decision, at 198-99.

In 2002, TMA announced that it would restructure TRICARE under a plan known as “TRICARE Next Generation” or “T-Nex.” Under the T-Nex plan, TMA will consolidate the MCS contracts from seven contracts covering eleven regions to three contracts covering three regions. T-Nex also calls for replacing the subcontracting scheme for dual eligible beneficiaries with one standalone contract for processing all dual eligible beneficiary claims, irrespective of geographic region. This new contract is called the “TRICARE Dual Eligible Fiscal Intermediary Contract” or “TDEFIC.” TMA estimates that, when fully implemented, TDEFIC will process claims for approximately 1.7 million dual eligible beneficiaries. Id. at 199.

TDEFIC provides for a nine-month transition schedule. The purpose of the schedule is to allow sufficient time to transition the chosen TDEFIC contractor into the new system for processing dual eligible beneficiary claims. During this transition period, PGBA and WPS are to continue *1222 processing dual eligible beneficiary claims as subcontractors under the old MCS contracts. In the event more than nine months is needed to make the transition, TDEFIC allows for extension of the transition period, in which case claims processing is to continue under the old MCS contracts. The original transition dates for TDEFIC were: (1) region 11 on April 1. 2004; (2) regions 2 and 5 on June 1, 2004; (3) regions 9, 10, and 12 on July 1, 2004; (4) regions 3 and 4 on August 1, 2004; (5) region 1 on September 1, 2004; (6) regions 7 and 8 on October 1, 2004; and (7) region 6 on November 1, 2004. Evidentiary Hr’g Tr. at 67-68 (Fed.Cl. May 6, 2004) (“Hearing”). On May 12, 2004, the date of the Court of Federal Claims’ final decision, region 11 had already transitioned while regions 2 and 5 were within three weeks of transitioning. 2

II.

On September 6, 2002, TMA issued a RFP for TDEFIC, to which PGBA, WPS, and Unisys Corporation responded with proposals in February of 2003. Upon receipt of the proposals, TMA conducted an initial evaluation. 3 Thereafter, it requested and received final proposal revisions from the three offerors. TMA evaluated the proposal revisions in June of 2003. The Source Selection Authority then conducted an independent evaluation of the proposals over the course of two weeks. TMA ultimately awarded TDEFIC to WPS on July 25, 2003. In total, it took TMA approximately six months to conduct the evaluation and award the contract.

On August 8, 2003, PGBA filed a post-award bid protest with the GAO. The GAO issued an automatic stay of the award to WPS pending resolution of the protest. However, on August 16, 2003, TMA overrode the automatic stay. PGBA responded by bringing an action in the Court of Federal Claims to enjoin the override. On September 15, 2003, Judge Allegra issued an injunction dissolving TMA’s override and reinstating the automatic stay. PGBA, LLC v. United States, 57 Fed.Cl. 655 (2003) (“Preliminary Injunction”). The GAO denied PGBA’s protest on November 17, 2003, In re PGBA, LLC, Nos. B-292679.2, B-292679.3 (U.S. Gen. Accounting Office Nov. 17, 2003) (filed under seal), at which time the automatic stay and preliminary injunction expired, PGBA LLC v. United States, No. 03-1986C (Fed. Cl. Nov. 17, 2003) (“Order”).

III.

On December 3, 2003, PGBA filed suit in the Court of Federal Claims, praying for the following relief:

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389 F.3d 1219, 2004 U.S. App. LEXIS 24268, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pgba-llc-v-united-states-and-wisconsin-physicians-service-insurance-cafc-2004.