HHS Awards $17.8M Medicaid Integrity Contract to Cotiviti Gov Services for Audit and Overpayment Services
Contract Overview
Contract Amount: $17,776,351 ($17.8M)
Contractor: Cotiviti GOV Services, LLC
Awarding Agency: Department of Health and Human Services
Start Date: 2008-09-09
End Date: 2020-08-31
Contract Duration: 4,374 days
Daily Burn Rate: $4.1K/day
Competition Type: FULL AND OPEN COMPETITION
Number of Offers Received: 3
Pricing Type: COST PLUS AWARD FEE
Sector: Healthcare
Official Description: AUDIT AND OVERPAYMENT MEDICAID INTEGRITY CONTRACT
Place of Performance
Location: OMAHA, DOUGLAS County, NEBRASKA, 68164
State: Nebraska Government Spending
Plain-Language Summary
Department of Health and Human Services obligated $17.8 million to COTIVITI GOV SERVICES, LLC for work described as: AUDIT AND OVERPAYMENT MEDICAID INTEGRITY CONTRACT Key points: 1. Contract focuses on critical Medicaid integrity functions, including audit and overpayment detection. 2. Cotiviti Gov Services, a known entity in healthcare analytics, secured this award. 3. The contract spans over a decade, indicating a long-term need for these services. 4. Spending is within the administrative management and consulting services sector.
Value Assessment
Rating: fair
The contract type is Cost Plus Award Fee, which can lead to higher costs if not managed carefully. Benchmarking against similar contracts is difficult without detailed performance data and fee structures.
Cost Per Unit: N/A
Competition Analysis
Competition Level: full-and-open
The contract was awarded under full and open competition, suggesting a robust price discovery process. However, the long duration and specific nature of the services might limit future competitive opportunities.
Taxpayer Impact: Taxpayer funds are utilized for essential Medicaid integrity functions aimed at reducing waste and fraud, potentially leading to significant savings.
Public Impact
Enhances the integrity of the Medicaid program by identifying and recovering improper payments. Supports federal and state efforts to combat healthcare fraud, waste, and abuse. Contributes to the financial sustainability of the Medicaid program. Provides valuable data and insights for policy improvements in healthcare administration.
Waste & Efficiency Indicators
Waste Risk Score: 50 / 10
Warning Flags
- Potential for cost overruns due to Cost Plus Award Fee structure.
- Long contract duration may reduce future competition and innovation.
- Reliance on a single contractor for critical integrity functions.
Positive Signals
- Awarded through full and open competition.
- Addresses a critical need for Medicaid program integrity.
- Contractor has expertise in healthcare analytics and government services.
Sector Analysis
This contract falls under administrative management and general management consulting services, a broad category. Benchmarking requires comparison with similar government contracts focused on healthcare program integrity and audit services.
Small Business Impact
The data indicates this contract was not set aside for small businesses and does not specify small business participation. Further analysis would be needed to determine if small businesses were involved as subcontractors.
Oversight & Accountability
The Centers for Medicare and Medicaid Services (CMS) is responsible for overseeing this contract. Oversight would focus on performance metrics, cost controls, and the effectiveness of audit and recovery efforts.
Related Government Programs
- Administrative Management and General Management Consulting Services
- Department of Health and Human Services Contracting
- Centers for Medicare and Medicaid Services Programs
Risk Flags
- Cost Plus Award Fee structure can lead to higher costs.
- Long contract duration (over 11 years) may limit future competition.
- Potential for contractor performance issues impacting recovery rates.
- Dependence on a single vendor for critical program integrity functions.
Tags
administrative-management-and-general-ma, department-of-health-and-human-services, ne, delivery-order, 10m-plus
Frequently Asked Questions
What is this federal contract paying for?
Department of Health and Human Services awarded $17.8 million to COTIVITI GOV SERVICES, LLC. AUDIT AND OVERPAYMENT MEDICAID INTEGRITY CONTRACT
Who is the contractor on this award?
The obligated recipient is COTIVITI GOV SERVICES, LLC.
Which agency awarded this contract?
Awarding agency: Department of Health and Human Services (Centers for Medicare and Medicaid Services).
What is the total obligated amount?
The obligated amount is $17.8 million.
What is the period of performance?
Start: 2008-09-09. End: 2020-08-31.
What is the estimated return on investment (ROI) for this contract in terms of recovered overpayments versus contract costs?
Quantifying the precise ROI is challenging without access to detailed performance reports and specific recovery data. However, the primary goal of such contracts is to identify and recoup improper payments, which, if successful, should yield a positive return. The effectiveness of the contractor in detecting fraud and errors is key to this ROI.
What are the key performance indicators (KPIs) used to measure the success of this contract, and how has Cotiviti performed against them?
Typical KPIs for such contracts include the volume and value of identified overpayments, the success rate of recovery efforts, the accuracy of audits, and adherence to timelines. Performance against these KPIs would be detailed in CMS's internal contract management records and performance reviews.
How does the Cost Plus Award Fee structure incentivize efficiency and cost control for Cotiviti, and what mechanisms are in place to prevent contractor overbilling?
The 'Award Fee' component incentivizes performance beyond minimum requirements, while the 'Cost Plus' aspect covers allowable costs. CMS employs rigorous auditing and review processes to scrutinize costs, ensure compliance with contract terms, and prevent overbilling. Performance metrics directly influence the award fee.
Industry Classification
NAICS: Professional, Scientific, and Technical Services › Management, Scientific, and Technical Consulting Services › Administrative Management and General Management Consulting Services
Product/Service Code: SUPPORT SVCS (PROF, ADMIN, MGMT) › ADMINISTRATIVE SUPPORT SERVICES
Competition & Pricing
Extent Competed: FULL AND OPEN COMPETITION
Solicitation Procedures: SUBJECT TO MULTIPLE AWARD FAIR OPPORTUNITY
Solicitation ID: FILE TAB 8
Offers Received: 3
Pricing Type: COST PLUS AWARD FEE (R)
Evaluated Preference: NONE
Contractor Details
Parent Company: Veritas Capital Fund Management, L.L.C.
Address: 2121 N 117TH AVE STE 200, OMAHA, NE, 68164
Business Categories: Category Business, Limited Liability Corporation, Not Designated a Small Business, Special Designations, U.S.-Owned Business
Financial Breakdown
Contract Ceiling: $17,776,351
Exercised Options: $17,776,351
Current Obligation: $17,776,351
Actual Outlays: $-444
Contract Characteristics
Commercial Item: COMMERCIAL PRODUCTS/SERVICES PROCEDURES NOT USED
Parent Contract
Parent Award PIID: HHSM500200800006I
IDV Type: IDC
Timeline
Start Date: 2008-09-09
Current End Date: 2020-08-31
Potential End Date: 2020-08-31 00:00:00
Last Modified: 2023-01-27
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