HHS awards $28.7M contract to Guidehouse Inc. for federal and state exchange improper payment measurement reviews

Contract Overview

Contract Amount: $28,736,528 ($28.7M)

Contractor: Guidehouse Inc.

Awarding Agency: Department of Health and Human Services

Start Date: 2023-08-18

End Date: 2027-12-31

Contract Duration: 1,596 days

Daily Burn Rate: $18.0K/day

Competition Type: FULL AND OPEN COMPETITION

Number of Offers Received: 1

Pricing Type: FIRM FIXED PRICE

Sector: Other

Official Description: SUPPORT THE FEDERAL EXCHANGE IMPROPER PAYMENT MEASUREMENT (FEIPM) REVIEW CYCLE AND THE STATE EXCHANGE IMPROPER PAYMENT MEASUREMENT (SEIPM) IMPROPER PAYMENT PRE-TEST AND ASSESSMENT (IPPTA). THE FEIPM PROGRAM GENERALLY CONSISTS OF ANNUALLY PREPARING F

Place of Performance

Location: MCLEAN, FAIRFAX County, VIRGINIA, 22102

State: Virginia Government Spending

Plain-Language Summary

Department of Health and Human Services obligated $28.7 million to GUIDEHOUSE INC. for work described as: SUPPORT THE FEDERAL EXCHANGE IMPROPER PAYMENT MEASUREMENT (FEIPM) REVIEW CYCLE AND THE STATE EXCHANGE IMPROPER PAYMENT MEASUREMENT (SEIPM) IMPROPER PAYMENT PRE-TEST AND ASSESSMENT (IPPTA). THE FEIPM PROGRAM GENERALLY CONSISTS OF ANNUALLY PREPARING F Key points: 1. Contract focuses on critical areas of improper payment measurement for federal and state health exchanges. 2. The contract duration of nearly 4 years suggests a sustained need for these services. 3. Administrative Management and General Management Consulting Services (NAICS 541611) is a broad category, requiring specific understanding of the services delivered. 4. The contract is a Delivery Order under a larger contract vehicle, indicating potential for future task orders. 5. The firm-fixed-price (FFP) contract type shifts performance risk to the contractor, potentially leading to cost efficiencies if managed well. 6. The award value of $28.7M over approximately 4 years warrants benchmarking against similar consulting engagements.

Value Assessment

Rating: good

The award value of $28.7 million over approximately 1596 days (roughly 4 years) for improper payment measurement reviews appears reasonable for specialized consulting services. Benchmarking against similar contracts for program integrity and payment accuracy reviews within HHS or other federal agencies would provide a more precise value assessment. The firm-fixed-price nature of the contract suggests that the contractor is responsible for managing costs to achieve the agreed-upon price, which can be a good indicator of value if the scope is well-defined and the contractor is efficient.

Cost Per Unit: N/A

Competition Analysis

Competition Level: full-and-open

The contract was awarded under full and open competition, indicating that multiple interested parties had the opportunity to bid. This process generally fosters a competitive environment, encouraging bidders to offer their best pricing and technical solutions. The fact that it was a delivery order under a larger contract vehicle suggests that the initial competition for the base contract was robust, and this order was placed competitively among eligible awardees.

Taxpayer Impact: Full and open competition is beneficial for taxpayers as it typically drives down prices through market forces and ensures that the government receives the most advantageous offers available.

Public Impact

The primary beneficiaries are the Centers for Medicare and Medicaid Services (CMS) and potentially state Medicaid agencies, who will receive support in identifying and reducing improper payments. The services delivered are crucial for ensuring the integrity of federal and state health exchange programs, safeguarding taxpayer funds. The geographic impact is national, as the FEIPM and SEIPM programs have broad reach across the United States. The contract supports the federal workforce by providing specialized expertise that may not be readily available internally, enhancing program oversight capabilities.

Waste & Efficiency Indicators

Waste Risk Score: 50 / 10

Warning Flags

The broad NAICS code (541611) could mask the specific nature of the consulting services, making it difficult to assess the true scope and cost-effectiveness without further detail.
Reliance on external consultants for core program integrity functions may raise questions about long-term internal capacity building.

Positive Signals

The contract is awarded under full and open competition, suggesting a competitive pricing environment.
The firm-fixed-price contract type aligns incentives for the contractor to perform efficiently and manage costs.
The duration of the contract (nearly 4 years) indicates a sustained and recognized need for these critical program integrity services.

Sector Analysis

This contract falls within the professional, scientific, and technical services sector, specifically management consulting. The federal government is a significant consumer of these services, particularly for program oversight, policy analysis, and operational efficiency. The market for such services is competitive, with numerous large and small firms vying for federal contracts. Benchmarking this award against other federal contracts for program integrity, audit support, or payment accuracy reviews would provide context on market rates and typical contract values.

Small Business Impact

The data indicates that this contract was not set aside for small businesses (ss: false, sb: false). While this specific award may not directly benefit small businesses through a set-aside, Guidehouse Inc. may engage small businesses as subcontractors. Analysis of subcontracting plans and actual performance would be necessary to determine the extent of small business participation and its impact on the small business ecosystem.

Oversight & Accountability

Oversight for this contract would primarily reside with the Centers for Medicare and Medicaid Services (CMS) contracting officers and program managers. The firm-fixed-price nature of the contract implies that performance standards and deliverables are clearly defined, with payments contingent upon meeting these requirements. Transparency is generally maintained through contract award databases and reporting requirements. Inspector General jurisdiction would apply if any fraud, waste, or abuse related to the contract is suspected.

Related Government Programs

Federal Exchange Improper Payment Measurement (FEIPM)
State Exchange Improper Payment Measurement (SEIPM)
Program Integrity Reviews
Payment Accuracy Initiatives
Medicaid Program Integrity

Risk Flags

Potential for data quality issues from source systems.
Complexity of identifying and quantifying all types of improper payments.
Reliance on contractor expertise for critical program integrity functions.

Frequently Asked Questions

What is this federal contract paying for?

Department of Health and Human Services awarded $28.7 million to GUIDEHOUSE INC.. SUPPORT THE FEDERAL EXCHANGE IMPROPER PAYMENT MEASUREMENT (FEIPM) REVIEW CYCLE AND THE STATE EXCHANGE IMPROPER PAYMENT MEASUREMENT (SEIPM) IMPROPER PAYMENT PRE-TEST AND ASSESSMENT (IPPTA). THE FEIPM PROGRAM GENERALLY CONSISTS OF ANNUALLY PREPARING F

Who is the contractor on this award?

The obligated recipient is GUIDEHOUSE INC..

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 $28.7 million.

What is the period of performance?

Start: 2023-08-18. End: 2027-12-31.

What specific methodologies and tools will Guidehouse Inc. employ to conduct the FEIPM and SEIPM reviews?

The contract likely specifies the required methodologies and tools, or at least the expected outcomes that necessitate certain approaches. Typically, improper payment reviews involve data analysis, statistical sampling, and detailed case file reviews to identify payments that were made in error due to reasons such as insufficient documentation, incorrect coding, or eligibility issues. Guidehouse Inc., as a management consulting firm, is expected to leverage its expertise in data analytics, process improvement, and regulatory compliance to design and implement effective review processes. This could include developing custom algorithms for anomaly detection, utilizing advanced data visualization tools for reporting, and employing standardized checklists for case reviews to ensure consistency and thoroughness. The specific tools and methods would be detailed in the Statement of Work (SOW) and any subsequent task directives issued under the delivery order.

How does the $28.7 million award compare to historical spending on similar improper payment measurement services by CMS?

To assess this, one would need to analyze historical contract data for CMS related to program integrity, payment accuracy, and improper payment measurement. This would involve searching federal procurement databases (like FPDS or USASpending.gov) for contracts with similar NAICS codes (e.g., 541611, 541690) and keywords related to improper payments, audits, and reviews within CMS. Comparing the annual or total value of this $28.7 million contract against the average or median values of comparable contracts awarded over the past 3-5 years would provide context. Factors such as contract duration, scope of work, and the specific programs covered (e.g., Medicare, Medicaid, ACA marketplaces) would need to be considered for a fair comparison. If this award is significantly higher or lower than historical benchmarks, it could indicate changes in market rates, increased scope, or potentially a more competitive bidding process.

What are the key performance indicators (KPIs) for this contract, and how will Guidehouse's performance be measured?

Key Performance Indicators (KPIs) for this contract would be defined in the Performance Work Statement (PWS) or Statement of Work (SOW). For improper payment measurement reviews, common KPIs might include the accuracy and timeliness of identifying improper payments, the completeness and quality of review documentation, adherence to sampling methodologies, and the effectiveness of reporting findings. Performance would likely be measured through regular progress reports submitted by Guidehouse, periodic reviews by CMS program officials, and potentially through metrics related to the reduction of improper payments achieved as a result of their work. The government would assess whether Guidehouse meets or exceeds these established KPIs, with potential implications for future contract awards or performance evaluations.

What is Guidehouse Inc.'s track record with federal contracts, particularly within the Department of Health and Human Services?

Guidehouse Inc. has a significant track record of performing federal contracts, including numerous awards within the Department of Health and Human Services (HHS) and its various agencies, such as CMS. A review of federal procurement data would reveal the types of services they have provided, their past performance ratings, and the total value of contracts awarded to them. Their experience often spans areas like program integrity, financial management, IT modernization, and healthcare consulting. Examining their history with similar contracts, especially those involving payment accuracy, fraud detection, and program evaluation, would provide insight into their capabilities and reliability in executing this specific delivery order. Positive past performance is a strong indicator of their ability to successfully deliver on this contract.

What are the potential risks associated with this contract, and what mitigation strategies are in place?

Potential risks include scope creep if the definition of 'improper payment' or the review cycle evolves significantly, leading to increased workload beyond the initial estimate. Another risk is the accuracy and completeness of the data provided by federal and state exchanges, which could impact the effectiveness of the reviews. Contractor performance risk also exists, where Guidehouse might not meet the required quality or timeliness standards. Mitigation strategies typically involve a clearly defined SOW, robust government oversight, regular communication channels between CMS and Guidehouse, and performance-based metrics. The firm-fixed-price nature also incentivizes the contractor to manage risks related to cost and schedule effectively. Furthermore, the contract likely includes clauses for addressing data quality issues and performance deficiencies.

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) › PROFESSIONAL SERVICES

Competition & Pricing

Extent Competed: FULL AND OPEN COMPETITION

Solicitation Procedures: SUBJECT TO MULTIPLE AWARD FAIR OPPORTUNITY

Offers Received: 1

Pricing Type: FIRM FIXED PRICE (J)

Evaluated Preference: NONE

Contractor Details

Parent Company: Peraton Technology Services Inc.

Address: 1676 INTERNATIONAL DR STE 800, MC LEAN, VA, 22102

Business Categories: Category Business, Corporate Entity Not Tax Exempt, Not Designated a Small Business, Special Designations, U.S.-Owned Business

Financial Breakdown

Contract Ceiling: $29,116,839

Exercised Options: $28,736,528

Current Obligation: $28,736,528

Actual Outlays: $15,350,637

Subaward Activity

Number of Subawards: 2

Total Subaward Amount: $6,318,046

Contract Characteristics

Commercial Item: COMMERCIAL PRODUCTS/SERVICES

Cost or Pricing Data: NO

Parent Contract

Parent Award PIID: GS00F045DA

IDV Type: FSS

Timeline