UnitedHealth Military & Veterans Services, LLC v. United States

132 Fed. Cl. 529, 2017 U.S. Claims LEXIS 825, 2017 WL 2929357
CourtUnited States Court of Federal Claims
DecidedMay 30, 2017
DocketNo. 16-1536C
StatusPublished
Cited by22 cases

This text of 132 Fed. Cl. 529 (UnitedHealth Military & Veterans Services, 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
UnitedHealth Military & Veterans Services, LLC v. United States, 132 Fed. Cl. 529, 2017 U.S. Claims LEXIS 825, 2017 WL 2929357 (uscfc 2017).

Opinion

Post-Award Bid Protest; Cross Motions for Judgment on the Administrative Record; Price Realism.

OPINION

HORN, J.

The protestor, UnitedHealth Military & Veterans Services, LLC (M & V), filed a [532]*532post-award bid protest in this court challenging the decision of defendant, the United States, through the United States Department of Defense, Defense Health Agency (DHA), to award two Managed Care Support (MCS) contracts for health, medical, and administrative support services for TRICARE-eligible beneficiaries to defendant-interve-nors, Humana Government Business, Inc. (Humana) and Health Net Federal Services, LLC (Health Net). Protestor filed suit in the United States Court of Federal Claims after the United States Government Accountability Office (GAO) issued a decision denying M & V's protest. See generally UnitedHealth Military & Veterans Servs., LLC, et al., B-411837.2 et al., 2016 WL 6821970 (Comp. Gen. Nov. 9, 2016).

TRICARE Program Background

This bid protest challenges the award of the “T-2017” procurement for MCS services for the United States Department of Defense TRICARE program, which is the United States Department of Defense’s managed healthcare program for service members, retirees, and their families and survivors.2 The total non-overseas population of TRICARE-eligible beneficiaries in the United States was estimated by DHA in its acquisition strategy memorandum as approximately 9.2 million. Under the TRICARE program, the Department of Defense provides healthcare through military treatment facilities (MTFs) or reimburses private sector healthcare providers for healthcare services provided to eligible beneficiaries. The DHA is responsible for operating the TRICARE program.3

Because the military’s direct healthcare system does not fully satisfy the military’s healthcare needs, the Department of Defense awards contracts to MCS contractors to support the military health system and to optimize the delivery of healthcare services to all TRICARE-eligible beneficiaries. MCS contract services include:

[Establishing civilian provider networks in designated geographic areas that meet statutorily-defined access standards for TRICARE Prime enrollees; providing comprehensive health care services to Prime enrollees whose primary care managers are TRICARE network providers and to users of TRICARE Extra and Standard; assisting military treatment facility ... Commanders in optimizing healthcare delivery in the direct care system, providing referrals for specialty services to an MTF provider prior to a civilian provider; enrolling beneficiaries in PRIME; paying healthcare claims for private sector medical services rendered to TRICARE eligi-bles; providing customer service and beneficiary/provider education activities for all TRICARE eligibles; and disease management.

As the acquisition strategy for the “T-2017” procurement explained, “[t]his acquisition is to purchase administrative and support services for the receipt of health care from the private sector and for the integration of that private sector care with the DoD [Department of Defense] direct care system.”

The “T-2017” procurement follows the current TRICARE contracts, referred to as TRICARE Third Generation, or “T-3” contracts, and the “T-2017” procurement represents the fourth generation of such MCS contracts since 1996. The “T-3” contracts have been held by three separate MCS contractors, each responsible for one region of the country: North, South, or West. Huma-na, Health Net, and M & V are the current TRICARE incumbent contractors performing the “T-3” contracts. Health Net holds the “T-3” contract for the North Region, Huma-na holds the “T-3” contract for the South Region, and M & V holds the “T-3” contract for the West Region. Distinct from the earlier “T-3” contracts, and as discussed further [533]*533below, the “T-2017” procurement, at issue in this bid protest, divided the country into two regions, East and West.4 The “T-2017” procurement contemplated that DHA would award two “T-2017” contracts, one for the East Region and one for the West Region.

The “T-2017” Solicitation

To initiate the “T-2017” procurement, DHA issued Request for Proposals No. HT9402-15-R-0002 (the solicitation) on April 24, 2015, seeking two MCS contractors to “assist the Military Health System (MHS) in operating an integrated healthcare delivery system combining resources of the militaras direct medical care system and the Contractor’s managed care support to provide health, medical and administrative support services to TRICARE-eligible beneficiaries.”5 Under the “T-2017” contracts, the contractors would be required to perform the services necessary to support the TRICARE program, including establishing and maintaining provider networks, managing referrals between the military treatment facilities and the civilian network, managing beneficiary enrollment, providing medical management services, providing readily accessible customer service, and processing claims. Section C of the solicitation set forth four contract objectives: readiness, experience of eare, manage per capita cost, and population health.

According to the solicitation, DHA intended to conduct a best value source selection and award two contracts, “consisting primarily of cost-plus fixed-fee types, with fixed-price elements, cost reimbursable elements and performance incentive fees....” DHA intended to select the best overall offer for the East and West Regions, “based upon an integrated assessment of teehnieal/management, past performance, and price/eost factors.”6 The solicitation stated that DHA would “conduct a full and open competition after exclusion of sources in this solicitation to foster an adequate number of viable Contractors to reduce any risk to the stability of the administration of the TRICARE program, and to ensure the continuous availability of healthcare services for TRICARE beneficiaries.” The East Region Contract was to cover approximately 5.9 million TRICARE-eligible beneficiaries, and the West Region Contract was to cover approximately 2.9 million TRICARE-eligible beneficiaries.7 The solicitation explained that DHA would select two different prime contractors “even if a potential Contractor submits proposals for more than one contract region and each of the proposals is evaluated as the best value for the Government for the contract region of submission.” Although DHA intended to award two contracts to two different prime contractors, offerors were permitted to submit proposals on one or both regions. According to the solicitation, if an offeror was determined to have' submitted best value proposals for both the East and West Regions, “the Offeror will be awarded the East Region contract, provided at least one other acceptable offer” was submitted for the West Region contract. The West Region contract would then go to the next best value proposal for the West Region. The “T-2017” contracts [534]*534would consist of a base period of at least nine months, five one-year options periods, and a transition-out period.

Relevant to this bid protest, the solicitation identified Contract Line Items (CLINs) for the work to be performed. CLINs X001 covered the reimbursable “Underwritten Healthcare Cost” for TRICARE Prime en-rollees, non-Prime underwritten beneficiaries, and military treatment facility enrollees.

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132 Fed. Cl. 529, 2017 U.S. Claims LEXIS 825, 2017 WL 2929357, Counsel Stack Legal Research, https://law.counselstack.com/opinion/unitedhealth-military-veterans-services-llc-v-united-states-uscfc-2017.