Wisconsin Physicians Service Insurance Corporation v. United States

CourtUnited States Court of Federal Claims
DecidedNovember 19, 2020
Docket20-835
StatusPublished

This text of Wisconsin Physicians Service Insurance Corporation v. United States (Wisconsin Physicians Service Insurance Corporation 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
Wisconsin Physicians Service Insurance Corporation v. United States, (uscfc 2020).

Opinion

In the United States Court of Federal Claims No. 20-835C (Filed Under Seal: October 28, 2020) (Reissued for Publication: November 19, 2020) *

************************************ * WISCONSIN PHYSICIANS SERVICE * INSURANCE CORPORATION, * * Plaintiff, * * v. * * Postaward Bid Protest; Cross-Motions for THE UNITED STATES, * Judgment on the Administrative Record; * Standing; Evaluation of Proposals; Defendant, * Technical Acceptability; Disparate * Treatment Allegations; OCI Mitigation and * * NATIONAL GOVERNMENT SERVICES, * INC., * * Defendant-Intervenor. * ************************************ *

Daniel P. Graham, Washington, DC, for plaintiff.

Rafique O. Anderson, United States Department of Justice, Washington, DC, for defendant.

Anuj Vohra, Washington, DC, for defendant-intervenor.

OPINION AND ORDER

* The court issued this Opinion and Order under seal on October 28, 2020, and directed the parties to submit proposed redactions by November 17, 2020. The parties filed a status report in which they indicate that certain redactions are agreed to by all parties. Those redactions are acceptable to the court. Defendant and defendant-intervenor further agreed to certain redactions to Section II.B.4 of this opinion, which plaintiff opposes. The court adopts the disputed redactions for the following primary reasons: (1) this opinion analysis section is an alternative review of the merits of a protest ground that has already been dismissed on standing grounds; (2) the topic of the analysis, the parties’ arguments concerning a conflict of interest mitigation plan, is fact-specific and not readily applicable to other procurements; (3) the redacted material would expose confidential and proprietary information in a highly competitive marketplace. All redactions are indicated by bracketed ellipses (“[. . .]”). SWEENEY, Senior Judge

In this postaward bid protest, plaintiff Wisconsin Physicians Service Insurance Corporation (“WPS”) contends that the Centers for Medicare and Medicaid Services (“CMS”), part of the United States Department of Health and Human Services, improperly eliminated the proposal submitted by WPS from a competition to provide Medicare Administrative Contractor (“MAC”) services. The awardee of the contract, National Government Services, Inc. (“NGS”), intervenes in this suit. WPS seeks a permanent injunction of the award to NGS.

Before the court are cross-motions for judgment on the administrative record filed by WPS and the United States pursuant to Rule 52.1(c) of the Rules of the United States Court of Federal Claims, along with a combined motion to dismiss and cross-motion for judgment on the administrative record filed by NGS. For the reasons set forth below, the court grants in part and denies in part NGS’s motion to dismiss, grants NGS’s and defendant’s motions for judgment on the administrative record, and denies WPS’s motion for judgment on the administrative record and its request for permanent injunctive relief.

I. BACKGROUND

A. History of the Procurement

1. Request for Proposal

CMS contracts with MACs to provide Medicare Part A and Part B claims administration and ancillary services; CMS divides this work among regional jurisdictions. Corrected Administrative R. (“AR”) 81-82, 131. On February 1, 2019, CMS issued Request for Proposal No. 75FCMC19R002 (“RFP”) for Jurisdiction 6 (“J6”), which includes Illinois, Minnesota, and Wisconsin. 1 Id. Tab 10. The contracting vehicle is a “Cost Reimbursement type contract,” with a primary pricing structure of Cost-Plus-Award-Fee. Id. at 1790. If all six option years are exercised, the awarded contract would be performed for seven years. Id. at 1798.

The RFP was amended on March 5, 2019, and again on March 21, 2019. Id. Tabs 17-18. Offerors were to submit their proposals in five separate volumes: Administrative Requirements and Responsibility Determination; Proposal Assumptions; Technical Proposal; Business Proposal; and Conflict of Interest. Id. at 1879. Proposals were due on April 1, 2019. Id. at 1878.

2. Evaluation Scheme

CMS chose a best-value evaluation model where “[a]ward will be made to the Offeror whose proposal offers the best overall value to the Government.” Id. at 1915. Accordingly, the

1 J6 includes additional types of Medicare claims administration services for other states and territories. AR 173.

-2- RFP “permits tradeoffs among cost or price and the non-cost factors and allows the Government to accept other than the lowest priced proposal.” Id. The three evaluation factors in this MAC selection process are Technical Approach, Past Performance, and Cost/Price. Id. at 1915-16.

The three evaluation factors are divided into two categories: (1) the technical evaluation of non-cost/price factors, which includes both the Technical Approach and Past Performance factors; and (2) the Cost/Price factor. Id. To arrive at the best-value proposal, the following weighting scheme applies: (1) the “Technical Approach evaluation factor is more important than the Past Performance evaluation factor”; and (2) “Technical Approach and Past Performance, when combined, are significantly more important than cost or price.” Id. at 1915. For the non-cost/price factors, the evaluators would identify strengths, weaknesses, significant weaknesses, and deficiencies in the offerors’ proposals. Id. at 1192. The evaluation of the cost/price of proposals is not a primary issue in this protest, but that process, which does not produce an evaluation rating, includes “a price analysis, cost analysis, and cost realism analysis.” Id. at 1916.

The Past Performance evaluation factor pertains to relevant past performance information that “is expected to demonstrate the likelihood that the prospective contract will be performed successfully.” Id. at 1894. Possible ratings under this factor are High Confidence, Solid Confidence, Satisfactory Confidence, Low Confidence, or Neutral, all tied to the level of the evaluators’ “expectation that the Offeror will successfully meet the contract performance requirements.” Id. at 1192. A Neutral rating on this factor is only assigned to offerors with “no record of relevant past performance.” Id.

The key evaluation factor for the disputed issues in this protest is Technical Approach. This factor is composed of three criteria, each of which is addressed in a separate tab in the offeror’s Technical Proposal volume: Program Management, Staffing Plan, and Mission Essential Functions (“MEFs,” or “MEF” when discussing just one element within the MEFs evaluation criterion). Id. at 1890. The MEFs criterion is subdivided into seven MEFs: Implementation, Provider Enrollment, Provider Customer Service Program, Claims Processing, Appeals, Medical Review, and Audit & Reimbursement. Id. at 1899. Possible ratings under the Technical Approach factor are Excellent, Good, Acceptable, and Unacceptable. Id. at 1191.

CMS would also look outside the offeror’s Technical Proposal volume by examining the offeror’s underlying assumptions, to better understand the offeror’s Technical Approach. Id. at 1888-89. Much of the attention in this protest is focused on the Basis of Estimate (“BOE”) spreadsheet that each offeror would supply in its Proposal Assumptions volume. Id. According to the RFP, “the BOE and other relevant historical data available to CMS [would] be used as a baseline tool for measuring and understanding how the Offeror proposes to perform the [Statement of Work (“SOW”)] requirements in contrast to how the Offeror has historically performed MAC work or similar work.” Id. at 1888. The spreadsheet template was provided by CMS and many of the formulas for populating the cells of the spreadsheet were fixed and could not be altered. Id. Tabs 72-73.

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