United Payors & United Providers Health Services, Inc. v. United States

55 Fed. Cl. 323, 2002 U.S. Claims LEXIS 372, 2003 WL 1069697
CourtUnited States Court of Federal Claims
DecidedDecember 19, 2002
DocketNo. 02-1135C
StatusPublished
Cited by36 cases

This text of 55 Fed. Cl. 323 (United Payors & United Providers Health Services, Inc. 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
United Payors & United Providers Health Services, Inc. v. United States, 55 Fed. Cl. 323, 2002 U.S. Claims LEXIS 372, 2003 WL 1069697 (uscfc 2002).

Opinion

OPINION

MARGOLIS, Senior Judge.

This post-award bid protest brought by United Payors and United Providers Health Services, Inc. (“UP & UP”) against the United States, acting through the United States Department of Health and Human Services (“HHS”), is before the Court on plaintiffs motion for injunctive relief, defendant’s partial motion to dismiss, and defendant’s motion for judgment upon the administrative record. After careful consideration of the briefs and the oral argument, plaintiffs motion for injunctive relief is granted. Defendant’s partial motion to dismiss and motion for judgment upon the administrative record are denied.

FACTS

This dispute arises out of a contract that the HHS awarded to CRAssociates (“CRA”) in response to request for proposal number 282-99-0001 (“the solicitation”). HHS originally issued the solicitation in August 1998. After a successful bid protest by CRA, the solicitation was reissued in August 2000.

1. Solicitation

The purpose of the solicitation was to request proposals for a cost-reimbursement contract in which the awardee would provide health care services to detainees of the Immigration and Naturalization Service (“INS”) for a period of five years. The contractor would be required to perform various and distinct tasks related to the detainees’ health care service. Task I requires the contractor to provide certain medical staffing for various INS medical facilities. Task II specifies that the contractor would provide on-site medical and support services to augment existing resources at designated INS facilities. Task III requires the contractor to establish an integrated health care system for the detainees, and is broken into three sub-parts: Task IIIA states that the contractor will establish a preferred provider network; Task IIIB requires that the contractor process claims for all payments to providers and institutions that provide medical services to the detainees; and Task IIIC mandates the construction of a system by which the contractor can conduct utilization and quality management reviews. Task TV is a pass-through requirement in which the contractor must pay all claims for medical support services rendered to the detainees housed throughout the country that were incurred pursuant to other provisions in the contract.

The solicitation outlines the criteria to be used in evaluating the proposals. The proposals would first be evaluated on the offer- or’s: (1) technical approach; (2) financial and management capability; and (3) past performance. “[I]f two or more proposers’ acceptable proposals [were found to be] essentially equal, then business management competence and total cost/priee [would] become the final determining factor. Furthermore, cost/ prices [would] be evaluated on the basis of cost realism which is defined as the offeror’s ability to project costs which are reasonable and indicate that the offeror understands the nature and the extent of the work [that was to be] performed.” (Admin. R., at 77.)

2. Proposals

[325]*325CRA and UP & UP2 were the only two offerors in the competitive range. After performing several rounds of technical evaluations, HHS determined that the proposals by CRA and UP & UP were technically equivalent, and that the final determining factor would therefore be price.3

In its initial proposal, CRA estimated that the total cost to the Government for full performance of the contract by CRA would be $221,541,235. HHS later revised that estimate to $* * *.4 UP & UP estimated that the total cost to the Government for full performance of the contract by UP & UP would be $227,532,203. Therefore, UP & UP’s proposal estimated costs that were $* * * higher than those estimated by CRA, as revised by HHS.

UP & UP and CRA used two distinctly different methods to arrive at their respective proposal estimates, especially with regard to claims processing. CRA proposed to subcontract the claims processing work to * * *, and charge the Government a flat rate of $* * * per claim processed. CRA premised its entire proposal on its assumption that “[t]he number of claims to be processed annually equals [* * *].” (Admin. R., at 323.) CRA’s proposal contained a line item for “[* * *] Claims Office” for a total of $* * *, calculated by multiplying the $* * * per-claim rate by * * * claims per year by five years. In addition to the $* * * * * * Claims Office charge, CRA proposed five-year totals of $* * * for other direct costs (“ODCs”) and $* * * for “[* * *] Utilization Management,” expressly stating that each proposed amount was for capacity of “up to t* * *] claims.” (Admin. R., at 344.) CRA also proposed to add * * *% of total costs for general and administrative (“G & A”) expenses, and fees of * * *% for the first three years, and * * *% for the fourth and fifth years. CRA’s proposal did not address how its estimated costs would change if the number of claims exceeded the assumed * * * per year.

UP & UP did not propose to charge HHS for claims processing on a per-claim basis. Instead, it proposed a number of employees to perform the work, and included the wage rates for such employees in its proposed cost figure. UP & UP had been the contractor on the predecessor contract, and based its proposal not on the expected number of claims, but on past experience in processing the claims in question.

3. Number of Claims

The central issue in this case revolves around HHS’s failure to estimate, in the solicitation, the number of claims that would be processed under this contract. Several times during the negotiation process, HHS was formally asked the estimated number of claims that were to be processed. Each time, HHS responded with vague answers. When asked formally and directly “what number of claims should be used in preparing the cost proposal,” HHS responded by stating that “[t]here is no historical data available at this time. The number of claims depends on the health of the detained population in future years. This is an ‘unknown.’ ” (Admin. R., at 250.)

[326]*326Although CRA does not acknowledge that this exchange occurred, the contracting officer made handwritten notations in the administrative record that suggest that he had informed CRA that the number of claims to be expected would be approximately 30,000 per year. (Admin. R., at 253, 260.) In any case, CRA acknowledges that an offeror

could derive an approximate number of total claims by extrapolating the information that was provided by HHS... HHS indicated that approximately 6700 claims had been processed during fiscal year 1998 from the [INS Service Processing Centers (“SPSs”)] and [Contact Detention Services (“CDCs”)]. The Solicitation included a table which identified the approximate number of detainees at the SPCs, CDCs and jails in the fiscal year 1998 and for the subsequent five fiscal years, up until 2003. (Admin. R., at 135.) Using the claims figure of 6700 for SPCs and CDCs and the population figures for SPCs and CDCs, an offeror could project that the contractor would process about 1.5 claims per detainee. In order to extrapolate this figure into an average annual number of claims figure, an offeror could multiply 1.5 by the average annual population of detainees expected under the contract. HHS indicated that they expected to award the contract by January 1, 1999.

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55 Fed. Cl. 323, 2002 U.S. Claims LEXIS 372, 2003 WL 1069697, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-payors-united-providers-health-services-inc-v-united-states-uscfc-2002.