QualMed, Inc. v. Office of Civilian Health & Medical Program of the Uniformed Services

934 F. Supp. 1227, 1996 U.S. Dist. LEXIS 10802, 1996 WL 428512
CourtDistrict Court, D. Colorado
DecidedJuly 25, 1996
DocketNo. 95-D-2686
StatusPublished
Cited by1 cases

This text of 934 F. Supp. 1227 (QualMed, Inc. v. Office of Civilian Health & Medical Program of the Uniformed Services) is published on Counsel Stack Legal Research, covering District Court, D. Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
QualMed, Inc. v. Office of Civilian Health & Medical Program of the Uniformed Services, 934 F. Supp. 1227, 1996 U.S. Dist. LEXIS 10802, 1996 WL 428512 (D. Colo. 1996).

Opinion

MEMORANDUM OPINION AND ORDER

DANIEL, District Judge.

1. INTRODUCTION

This procurement and government contracting dispute is before the Court on the parties’ cross motions for summary judgment. Plaintiff QualMed, Inc. (“QualMed”) seeks summary judgment in its favor on the grounds that a bid protest recommendation of the General Accounting Office (“GAO”), recommending termination of a substantial government contract award to QualMed and subsequent award of the contract to Foundation Health Federal Services, Inc. (“Foundation”), and the decision of the Office of Civilian Health and Medical Program of the Uniformed Services (“OCHAMPUS”), adopting this recommendation, were arbitrary and capricious and/or unlawful.1 Defendants and Intervenor-Defendant Foundation request that judgment enter as a matter of law in their favor, arguing that the GAO’s and OCHAMPUS’ actions were rational and lawful and that no genuine issue, of material fact exists ■ as a matter of law as to QualMed’s claims.

For the reasons discussed below, I find that the GAO’s decision was neither arbitrary nor capricious, an abuse of discretion or contrary -to law. I further find that OCHAMPUS’ decision to ádopt the GAO’s recommendation was rational.' Accordingly, Defendants’ Joint Motion for Summary Judgment is GRANTED, and QualMed’s Motion for Summary Judgment is DENIED.

II. FACTS2

OCHAMPUS oversees the Civilian Health and Medical Program of the Uniformed Ser[1231]*1231vices (“CHAMPUS”), a program under which dependents of active and retired military personnel and their dependents are eligible to receive health care. In 1992, OCHAMPUS conducted a negotiated procurement for the award of a health care contract for CHAMPUS beneficiaries in California and Hawaii. The Request for Proposals (“RFP”) stated that the contract was to be awarded for an initial transition period of six months with five subsequent one-year options. However, it is presumed that due to the significant amount of time and costs associated with implementing such a contract, the contract term will last five years provided satisfactory performance by the awardee. On July 27, 1993, the contract was awarded to Aetna Government Health Plans, Inc. (“Aetna”).

Protests to the GAO were filed by both QualMed and Foundation. In response, the GAO sustained these protests. Foundation Health Fed. Services, Inc.; QualMed, Inc., B-254397.4 et al., December 20, 1993, 94-1 CPD ¶ 3 at 43. The basis for the GAO’s decision was a finding that OCHAMPUS had “failed to reasonably evaluate the merit of the offerors’ technical approaches as they related to the task of containing health care costs,” and the cost analysis was inconsistent with the evaluation criteria in the solicitation. Id. at 41. Specifically, the GAO found that OCHAMPUS’ failure to evaluate the technical proposals, “what the [Source Selection Evaluation Board] chair called ‘the heart of managed care’ — was left by default, to the Lewin-VHI consultant who had constructed the agency’s independent cost estimate.” Id. at 37. Thus, the GAO found that “LewinVHI personnel created the methodology for evaluating cost proposals”. and that “OCHAMPUS personnel, including the source selection authority, did not appear to realize that Lewin-VHI had substituted [certain of] its own ... figures for the estimates of health care costs proposed by the offerors.” See the GAO Decision at issue herein, Aetna Government Health Plans, Inc.; Foundation Health Services, Inc., B-254397.15 et al., July 27, 1995, 95-2 CPD ¶ 129 at 3, n. 3 (hereinafter “GAO Decision”).

As a result of these findings, the GAO recommended that OCHAMPUS revise the solicitation to accurately advise offerors of the method by which cost proposals would be evaluated, or reopen discussions with the offerors and request revised proposals before proceeding with the selection. Foundation, 94-1 CPD ¶ 3 at 43. The GAO further recommended that Aetna be allowed to perform the contract in the meantime. Id. OCHAMPUS implemented the recommendation by substantially revising the RFP as well as the internal methodology for evaluation proposals. Lewin-VHI (“Lewin”) continued to play a key role in the procurement, helping with the revisions to the RFP and the methodology. See GAO Decision at 3 & n. 3.

Thereafter, OCHAMPUS undertook the most recent phase of the procurement by issuing an amended RFP in February 1994. This RFP stated that OCHAMPUS would award the contract to the offeror submitting the proposal that was “most advantageous” to the Government, that it would develop a best-buy score for each offeror to assist it in making that decision, and that OCHAMPUS reserved the right to award the contract to an offeror other than the offeror having the highest best-buy score if that was in the best interests of the Government. The RFP resulted in an award of the contract to QualMed on March 31,1995.

QualMed asserts that the decision to award the contract to it was based on the determination that QualMed’s proposal was more advantageous than other proposals, including Foundation’s, and was less costly.3 The “best buy” calculation resulted in Foundation having a slightly higher score than QualMed; however, QualMed argues that OCHAMPUS viewed the scores as essentially equal. QualMed contends that the Source Selection Authority (“SSA”) concluded that an award to QualMed was “most advantageous” to and would be in the “best interests” of the Government for a number of [1232]*1232reasons, including: (i) it proposed to place at risk more of its own funds; (ii) it proposed to use the same health care subcontractor in Hawaii that Aetna was using so that the beneficiaries would not have to change providers; (iii) the total expected cost to the Government was lower; and (iv) the relationship of Foundation’s evaluated health care cost to the cost level at which the Government would become 100% responsible for any higher health care costs was less favorable to the Government than QualMed’s.

Defendants and Intervenor-Defendant Foundation assert that the GAO found that Foundation’s technical proposal was scored more highly than QualMed’s, and that Foundation’s proposed contract price was slightly less than QualMed’s. However, the evaluation of cost proposals by Lewin and a third party evaluator, Actuarial Research Corporation (“ARC”), resulted in QualMed having a lower evaluated price. Notwithstanding these factors, it is undisputed that Foundation was evaluated as having the “best buy” proposal by a slim margin over QualMed.

In April 1995, after the contract was awarded to QualMed, Aetna and Foundation filed timely protests with the GAO. A key issue in the protests was QualMed’s stated intention to use Value Behavioral Health (“VBH”), a subsidiary of Value Health, Inc. (“VHI”), as a subcontractor.4 Specifically, the protests asserted that VBH’s participation in the procurement as a proposed subcontractor created an unmitigatable organizational conflict of interest (“OCI”).5 The OCI arose from the fact that Lewin, the consultant who had been a key evaluator in the procurement, was also a subsidiary of VHI. As such, Lewin may have been in a position to significantly influence the outcome of the procurement.

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Bluebook (online)
934 F. Supp. 1227, 1996 U.S. Dist. LEXIS 10802, 1996 WL 428512, Counsel Stack Legal Research, https://law.counselstack.com/opinion/qualmed-inc-v-office-of-civilian-health-medical-program-of-the-cod-1996.