PGBA, LLC v. United States

60 Fed. Cl. 196, 2004 U.S. Claims LEXIS 91, 2004 WL 874807
CourtUnited States Court of Federal Claims
DecidedMarch 31, 2004
DocketNo. 03-2773-C
StatusPublished
Cited by112 cases

This text of 60 Fed. Cl. 196 (PGBA, 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
PGBA, LLC v. United States, 60 Fed. Cl. 196, 2004 U.S. Claims LEXIS 91, 2004 WL 874807 (uscfc 2004).

Opinion

OPINION AND ORDER 1

LETTOW, Judge.

This post-award bid protest is before the Court on plaintiff’s motion for judgment upon [198]*198the administrative record and the government’s and intervening-defendant’s cross-motions for judgment upon the administrative record. Plaintiff, PGBA, LLC (“PGBA”), filed this case to challenge the government’s award of a contract for the processing of certain beneficiaries’ claims under TRICARE, a military health care benefits program, to Wisconsin Physicians Service Insurance Corporation (‘WPS”), the intervening-defendant. PGBA previously challenged the award through the bid protest procedures available before the General Accounting Office (“GAO”). The contracting agency, the Department of Defense, Military Health Care System, TRICARE Management Activity (“TMA”), overrode the automatic stay in place while the bid protest was pending before GAO. That override was enjoined by Judge Allegra of this Court, thus re-instituting the stay and preventing the government and WPS from beginning implementation of the contract during the pendency of the proceedings before GAO. See PGBA, LLC v. United States, 57 Fed.Cl. 655, 656-57 (2003). GAO ultimately denied PGBA’s challenge, and the stay expired by operation of statute. PGBA filed this suit on December 3, 2003. The currently pending cross-motions have been fully briefed by the parties, and a hearing was conducted on March 3, 2004. For the reasons set forth below, the Court finds that the government committed errors that materially affected the bidding process adversely to PGBA. Applying 28 U.S.C. § 1491(b)(2), the Court declines to order injunctive or declaratory relief against the contractual award, but it concludes that PGBA is entitled to recover its reasonable costs incurred in bid preparation and proposal.

BACKGROUND

A. The Contract Solicitation

TRICARE is the government health care system that provides benefits to dependents of active duty service members as well as retired service members and their dependents. TMA administers TRICARE within the Department of Defense. TMA contracts with civilian companies to implement various aspects of the program. Over the course of the past several years, TMA has been undertaking a wide-reaching process of overhauling and restructuring this program in an effort to enhance the healthcare being provided and to reduce the costs being incurred. The contract specifically at issue in this case forms a part of this restructuring and involves the processing of claims made by “dual eligible” beneficiaries, that is, individuals who are eligible for coverage under both Medicare and TRICARE.

The TRICARE system is currently operated through a series of seven Managed Care Support (“MCS”) contracts that cover eleven regions within the United States and around the world. Compl. If 5. These MCS contracts have been in place since the early 1990s. Id. The MCS prime contractors each entered into subcontracts with one of two companies — PGBA or WPS — for the processing of beneficiaries’ claims. PGBA performs this task under five of the contracts representing nine regions. Compl. II6. WPS garnered the remaining two subcontracts regarding two regions. Id.

In October 2000 Congress passed “TRICARE for Life” legislation, Pub.L. 106-398, Div. A, Title VII, § 712, 114 Stat. 1654A-176 (Oct. 30, 2000) (codified at 10 U.S.C. § 1086(d) and 42 U.S.C. § 1395ggg). Def.’s Counter-Stmt, of Facts at 3. Prior to the enactment of this statute, when an individual who was eligible for TRICARE benefits became eligible for coverage under Medicare due to age or health, such an individual would lose his or her eligibility for TRICARE benefits. Compl. H7. However, pursuant to the TRICARE for Life law, individuals eligible for Medicare coverage now remain eligible for TRICARE benefits, with Medicare typically serving as the primary payer and TRICARE as secondary payer, [199]*199reimbursing only those portions of a claim not covered by Medicare. Def.’s CounterStmt. of Facts at 3-4.2 Upon passage of TRICARE for Life, TMA added the processing of dual-eligible beneficiaries’ claims to the existing MCS contracts by way of modifications to those contracts. Compl. H8. The MCS prime contractors, in turn, modified their subcontracts to incorporate processing of this new class of claims. Id. Accordingly, PGBA, as a subcontractor, took responsibility for processing approximately 82% of the dual-eligible beneficiaries’ claims, and WPS took on work regarding the remaining 18%. See Def.’s Counter-Stmt, of Facts at 4-5.

In 2002, TMA announced plans to reorganize the MCS system by consolidating the contracts and geographic coverage to three contracts covering three regions. Compl. H 9. The new system of contracts is known as “TRICARE Next Generation” or “T-Nex.”3 The T-Nex adjustments to the TRICARE system also incorporate a revision of the claim processing system for dual-eligible beneficiaries, replacing the existing sub-eontracting scheme with one stand-alone contract. This new contract will consolidate all claims processing for dual-eligible beneficiaries, without regard to the regional specifications related to the more comprehensive T-Nex contracts. TMA issued a Request for Proposals (“RFP”) for the new contract, labeled the “TRICARE Dual Eligible Fiscal Intermediary Contract” or “TDEFIC,” under Solicitation Number MDA906-02-R-007 on September 6, 2002. Compl. If 12. The TDEFIC was intended to provide claims-processing and associated customer-support services for approximately 1.7 million dual-eligible TRICARE beneficiaries. Id. The provision of services under the TDEFIC is scheduled to begin on April 1, 2004. AR B. 15, T. 68.4

The TDEFIC solicitation set forth the following evaluation criteria upon which TMA would rate proposals received from potential contractors (“offerors”):

M-2.2.1. The extent to which the proposal exhibits a clear understanding of the work requirements and the means required to fulfill the requirements.
M-2.2.2. The extent to which the proposal demonstrates an ability to meet or exceed the requirements defined in the RFP and the quality of service which is likely to result from implementation of an offerors’ [sic] proposed methods.
M-2.2.3. Feasibility of performing all RFP requirements within the total price proposed.

AR B. 8, T. 52 at 492. The solicitation also described evaluation factors and subfaetors that would be considered by TMA in making its decision:

Factor 1 -Technical Merit (includes proposal risk)
Subfactor 1 -Claims Processing
Subfactor 2 -Beneficiary and Provider Satisfaction
Subfactor 3 -Effective Management Approach
Subfactor 4 -Transition In
Subfactor 5 -Data Access
Factor 2 -Past Performance
Factor 3 -Price

AR B. 8, T. 52 at 493.

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60 Fed. Cl. 196, 2004 U.S. Claims LEXIS 91, 2004 WL 874807, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pgba-llc-v-united-states-uscfc-2004.