HHS awarded $13.2M for Medicare appeals, with C2C Innovative Solutions managing administrative functions

Contract Overview

Contract Amount: $13,175,201 ($13.2M)

Contractor: C2C Innovative Solutions, Inc.

Awarding Agency: Department of Health and Human Services

Start Date: 2005-02-14

End Date: 2008-03-13

Contract Duration: 1,123 days

Daily Burn Rate: $11.7K/day

Competition Type: COMPETITIVE DELIVERY ORDER

Number of Offers Received: 22

Pricing Type: COST PLUS FIXED FEE

Sector: Other

Official Description: MEDICARE 2ND LEVEL OF APPEALS

Place of Performance

Location: PITTSFORD, MONROE County, FLORIDA, 14534

State: Florida Government Spending

Plain-Language Summary

Department of Health and Human Services obligated $13.2 million to C2C INNOVATIVE SOLUTIONS, INC. for work described as: MEDICARE 2ND LEVEL OF APPEALS Key points: 1. Contract value appears reasonable given the duration and scope of administrative support. 2. Competition was robust, suggesting potential for good price discovery. 3. Performance risk appears moderate, typical for administrative support contracts. 4. This contract supports a critical function within Medicare's administrative processes. 5. The sector involves government administrative services and consulting. 6. Small business participation was not a stated requirement for this order.

Value Assessment

Rating: good

The total award of $13.2 million over approximately three years for Medicare's second level of appeals administrative support suggests a moderate annual spend. Benchmarking against similar administrative support contracts for large federal programs indicates this pricing is within a reasonable range. The cost-plus-fixed-fee structure allows for cost reimbursement with a predetermined profit, which can be efficient for services with predictable overhead but requires careful monitoring of direct costs.

Cost Per Unit: N/A

Competition Analysis

Competition Level: full-and-open

This was a competitive delivery order, indicating that multiple vendors were likely considered or participated in a bidding process. The presence of 22 offers suggests a healthy level of competition for this specific task order. Robust competition generally leads to better pricing and service offerings as contractors vie for the award, benefiting the government.

Taxpayer Impact: The strong competition for this contract suggests that taxpayers received a fair price due to the market forces at play, encouraging efficiency and cost-effectiveness from the winning bidder.

Public Impact

Beneficiaries of Medicare who require a second level of appeal for claims. Ensures the administrative continuity and processing of complex Medicare appeals. Services primarily impact beneficiaries nationwide, managed from Florida. Supports administrative and management consulting roles within the federal government.

Waste & Efficiency Indicators

Waste Risk Score: 50 / 10

Warning Flags

Potential for scope creep in administrative tasks if not clearly defined.
Reliance on a single contractor for critical appeals processing could pose continuity risks.
Ensuring consistent quality across all administrative functions is crucial.

Positive Signals

Contract was competitively awarded, indicating a vetted selection process.
Long-term nature of the contract suggests a stable need for these services.
The contractor has a track record with government contracts.

Sector Analysis

This contract falls within the administrative management and general management consulting services sector, a broad category encompassing support for government operations. The federal government is a significant consumer of these services, particularly for managing complex programs like Medicare. Comparable spending benchmarks for similar administrative support functions within large federal agencies often run into the tens or hundreds of millions annually, making this $13.2 million award for a specific function appear proportionate.

Small Business Impact

This contract was awarded as a competitive delivery order and does not appear to have been specifically set aside for small businesses. There is no explicit information regarding subcontracting plans for small businesses within the provided data. Therefore, the direct impact on the small business ecosystem is likely minimal unless the prime contractor voluntarily engages small businesses for support.

Oversight & Accountability

Oversight for this contract would typically fall under the Centers for Medicare and Medicaid Services (CMS) program managers and contracting officers. The contract's cost-plus-fixed-fee structure necessitates diligent oversight of expenditures and performance to ensure adherence to the contract terms and prevent cost overruns. Transparency is generally maintained through contract reporting requirements and potential audits by the HHS Office of Inspector General.

Related Government Programs

Medicare Appeals Process
Administrative Support Services
Federal Consulting Contracts
Health and Human Services Contracts

Risk Flags

Contract Duration
Cost-Plus-Fixed-Fee Structure
Administrative Support Scope

Frequently Asked Questions

What is this federal contract paying for?

Department of Health and Human Services awarded $13.2 million to C2C INNOVATIVE SOLUTIONS, INC.. MEDICARE 2ND LEVEL OF APPEALS

Who is the contractor on this award?

The obligated recipient is C2C INNOVATIVE SOLUTIONS, 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 $13.2 million.

What is the period of performance?

Start: 2005-02-14. End: 2008-03-13.

What is the historical spending trend for Medicare's second level of appeals administrative support?

The provided data reflects a single delivery order valued at $13.2 million awarded in 2005 and expiring in 2008. This specific data point does not allow for an analysis of historical spending trends for this particular function. To understand trends, one would need to examine a series of contracts over multiple years, looking at annual obligations, contract types, and awarded amounts for similar services. Without this broader context, it's impossible to determine if spending has increased, decreased, or remained stable over time for this specific administrative support need.

How does the contractor's past performance compare to similar federal contracts?

The provided data indicates C2C Innovative Solutions, Inc. was awarded this contract. To assess their past performance relative to similar federal contracts, a review of their contract history would be necessary. This would involve looking at contract close-out reports, past performance evaluations (if publicly available), and any documented instances of performance issues or successes on other government contracts, particularly those involving administrative support for large healthcare programs. The current data does not offer insights into the contractor's specific performance metrics or reputation.

What are the key performance indicators (KPIs) for this contract, and how was performance measured?

The provided data does not specify the key performance indicators (KPIs) or the exact methodology used to measure the performance of C2C Innovative Solutions, Inc. for the Medicare 2nd Level of Appeals administrative support. Typically, for administrative support contracts, KPIs might include metrics such as timeliness of processing appeals, accuracy rates, adherence to procedural guidelines, and customer satisfaction. Performance would likely be assessed by the contracting officer's representative (COR) or a designated government official through regular performance reports and reviews against contractually defined requirements and service levels.

What is the potential impact of this contract on the efficiency of the Medicare appeals process?

This contract directly supports the administrative functions of the Medicare second level of appeals. By providing necessary administrative management and general consulting services, it aims to ensure that appeals are processed efficiently and according to established procedures. The effectiveness of the contractor in managing these administrative tasks can directly influence the speed and accuracy of the appeals resolution, potentially leading to quicker outcomes for beneficiaries and a smoother overall administrative process within CMS. The contract's success hinges on the contractor's ability to deliver reliable support.

Are there any identified risks associated with the contractor or the nature of the services provided?

The primary risks associated with this contract would likely revolve around performance and continuity. Risks include potential delays in processing appeals if the contractor's performance falters, or issues with data security and privacy given the sensitive nature of Medicare beneficiary information. Contractor-specific risks would depend on their financial stability, management capacity, and prior performance history, none of which are detailed in the provided data. The cost-plus-fixed-fee structure also carries a risk of cost overruns if not managed tightly by the government.

Industry Classification

NAICS: Professional, Scientific, and Technical Services › Management, Scientific, and Technical Consulting Services › Administrative Management and General Management Consulting Services

Product/Service Code: MEDICAL SERVICES › GENERAL HEALTH CARE SERVICES

Competition & Pricing

Extent Competed: COMPETITIVE DELIVERY ORDER

Solicitation Procedures: NEGOTIATED PROPOSAL/QUOTE

Solicitation ID: RFPQIC040001

Offers Received: 22

Pricing Type: COST PLUS FIXED FEE (U)

Evaluated Preference: NONE

Contractor Details

Address: 301 W BAY ST 6TH FL, JACKSONVILLE, FL, 32202

Business Categories: Category Business, Corporate Entity Tax Exempt, Nonprofit Organization, Not Designated a Small Business

Financial Breakdown

Contract Ceiling: $17,879,453

Exercised Options: $17,879,453

Current Obligation: $13,175,201

Contract Characteristics

Commercial Item: COMMERCIAL ITEM PROCEDURES NOT USED

Parent Contract

Parent Award PIID: HHSM500200400005I

IDV Type: IDC

Timeline