Pgba, LLC v. United States

CourtCourt of Appeals for the Federal Circuit
DecidedNovember 22, 2004
Docket2004-5101
StatusPublished

This text of Pgba, LLC v. United States (Pgba, LLC 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
Pgba, LLC v. United States, (Fed. Cir. 2004).

Opinion

United States Court of Appeals for the Federal Circuit

04-5101

PGBA, LLC,

Plaintiff-Appellant,

v.

UNITED STATES,

Defendant-Appellee,

and

WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION,

Defendant-Appellee.

Kathleen E. Karelis, Miller & Chevalier Chartered, of Washington, DC, argued for plaintiff-appellant. On counsel were W. Jay DeVecchio and Lisanne E.S. Cottington.

Kyle Chadwick, Trial Attorney, Commercial Litigation Branch, Civil Division, United States Department of Justice, of Washington, DC, argued for defendant- appellee, United States. With him on the brief were Peter D. Keisler, Assistant Attorney General; David M. Cohen, Director; and Brian M. Simkin, Assistant Director.

Steven S. Diamond, Arnold & Porter LLP, of Washington, DC, argued for defendant-appellee, Wisconsin Physicians Service Insurance Corporation. Of counsel on the brief were Walter F. Zenner, Jr., Marc A. Stanislawczyk, Joseph M. Catoe and Matthew H. Solomson.

Appealed from: United States Court of Federal Claims

Judge Charles F. Lettow United States Court of Appeals for the Federal Circuit

__________________________

DECIDED: November 22, 2004 __________________________

Before RADER, SCHALL, and PROST, Circuit Judges.

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 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 TRICARE system was divided into eleven geographical

1 PGBA filed its first motion for reconsideration after the court issued its original order under seal. The court incorporated the denial of this motion in its March 31, 2004 opinion. Initial Decision, 60 Fed. Cl. at 222-23.

04-5101 2 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. 106-398, Div. A, Title VII, § 712, 114 Stat. 1654A-176 (2000). The

legislation addressed a problem confronting individuals qualifying for both TRICARE

and Medicare benefits—individuals known as “dual eligible beneficiaries.” Namely, prior

to the enactment of TRICARE 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

04-5101 3 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 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

2 As of the date of our decision in this case, all eleven regions were scheduled to have transitioned to TDEFIC. However, it is the circumstances that existed at the time of the Court of Federal Claims’ final decision on May 12, 2004, that are relevant to this appeal.

04-5101 4 the proposals, TMA conducted an initial evaluation.3 Thereafter, it requested and

received final proposal revisions from the three offerors. TMA evaluated the proposal

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