HHS awarded $24.1M for Medicare appeals, with C2C Innovative Solutions Inc. managing the contract

Contract Overview

Contract Amount: $24,140,411 ($24.1M)

Contractor: C2C Innovative Solutions, Inc.

Awarding Agency: Department of Health and Human Services

Start Date: 2010-01-01

End Date: 2013-03-31

Contract Duration: 1,185 days

Daily Burn Rate: $20.4K/day

Competition Type: FULL AND OPEN COMPETITION

Number of Offers Received: 1

Pricing Type: COST PLUS AWARD FEE

Sector: Other

Official Description: TAS::75 0511::TAS MEDICARE 2ND LEVEL OF APPEALS - PART B NORTH

Place of Performance

Location: JACKSONVILLE, DUVAL County, FLORIDA, 32202

State: Florida Government Spending

Plain-Language Summary

Department of Health and Human Services obligated $24.1 million to C2C INNOVATIVE SOLUTIONS, INC. for work described as: TAS::75 0511::TAS MEDICARE 2ND LEVEL OF APPEALS - PART B NORTH Key points: 1. The contract's value of $24.1 million over its period of performance suggests a significant investment in Medicare appeals processing. 2. The 'Administrative Management and General Management Consulting Services' category indicates a focus on operational efficiency and support. 3. The contract was awarded under 'Full and Open Competition', implying a robust bidding process. 4. The 'Cost Plus Award Fee' (CPAF) contract type allows for contractor compensation based on performance against defined criteria. 5. The contract duration of 1185 days (approximately 3.25 years) indicates a medium-term engagement for these services. 6. The primary place of performance is Florida, suggesting a concentration of operations or beneficiaries in that region.

Value Assessment

Rating: fair

Benchmarking the value of this contract requires more granular data on the specific services provided and the complexity of Medicare appeals. However, $24.1 million over three years for specialized administrative and consulting services related to a critical government program like Medicare suggests a substantial, but not necessarily excessive, investment. The CPAF structure incentivizes performance, which can lead to better value if objectives are met. Without comparable contract data for similar Medicare appeals processing or administrative support, a precise value-for-money assessment is challenging.

Cost Per Unit: N/A

Competition Analysis

Competition Level: full-and-open

The contract was awarded under 'Full and Open Competition,' indicating that all responsible sources were permitted to submit a bid. This suggests a competitive environment where multiple companies likely vied for the contract. The number of bidders is not specified, but the open competition generally promotes price discovery and can lead to more favorable pricing for the government compared to sole-source or limited competition scenarios.

Taxpayer Impact: A full and open competition provides taxpayers with assurance that the government sought the best possible value by allowing a wide range of qualified contractors to compete, potentially driving down costs and improving service quality.

Public Impact

Beneficiaries of Medicare Part B who are undergoing second-level appeals will benefit from the services provided, ensuring their cases are processed. The contract delivers administrative management and general management consulting services specifically for the Medicare appeals process. The primary geographic impact is in Florida, where the contract's performance is centered. The contract supports a critical function within the healthcare system, indirectly impacting healthcare providers and the administrative workforce involved in appeals.

Waste & Efficiency Indicators

Waste Risk Score: 50 / 10

Warning Flags

The Cost Plus Award Fee (CPAF) structure, while incentivizing performance, can sometimes lead to higher overall costs if award fees are consistently maximized without strict cost controls.
Lack of specific performance metrics or outcomes makes it difficult to fully assess the effectiveness and efficiency of the services rendered.
The broad category of 'Administrative Management and General Management Consulting Services' could encompass a wide range of activities, making it hard to pinpoint specific areas of potential inefficiency without further detail.
The contract's duration and value, while substantial, do not inherently guarantee optimal value for taxpayer dollars without ongoing performance monitoring and evaluation.

Positive Signals

The award was made under 'Full and Open Competition,' indicating a competitive process that should have yielded a fair price and qualified contractor.
The use of a Cost Plus Award Fee (CPAF) contract type suggests an effort to incentivize contractor performance and achieve specific, measurable outcomes.
The contract addresses a critical government function – Medicare appeals – indicating its importance and the need for reliable service delivery.
The contractor, C2C Innovative Solutions, Inc., was selected through a competitive process, implying they met the government's requirements and demonstrated capability.

Sector Analysis

This contract falls within the professional, scientific, and technical services sector, specifically focusing on administrative and management consulting. This sector is crucial for government operations, providing expertise that agencies may not possess internally. The market for such services is competitive, with numerous firms offering specialized support. The value of this contract, $24.1 million, is moderate within the broader context of federal IT and professional services spending, but significant for the specific function of Medicare appeals.

Small Business Impact

The data indicates that small business participation was not a primary focus for this specific contract, as 'sb' is false. There is no explicit mention of small business set-asides or subcontracting requirements in the provided data. This suggests that the prime contractor was not a small business, and the contract may not have had specific provisions to ensure significant subcontracting opportunities for small businesses within its scope.

Oversight & Accountability

Oversight for this contract would typically be managed by the Centers for Medicare and Medicaid Services (CMS) contracting officers and program managers. Performance would be monitored against the terms of the Cost Plus Award Fee (CPAF) contract, including specific performance standards and award fee criteria. Transparency is generally maintained through contract award databases and reporting requirements, though detailed operational oversight information is often internal. The Inspector General for the Department of Health and Human Services would have jurisdiction for audits and investigations into potential fraud, waste, or abuse.

Related Government Programs

Medicare Part B Appeals
Administrative Management Services
Healthcare Consulting Services
Federal Contract Management
CMS Operations Support

Risk Flags

Potential for cost overruns due to CPAF structure
Difficulty in benchmarking value without comparable data
Lack of specific performance outcome data in public records

Frequently Asked Questions

What is this federal contract paying for?

Department of Health and Human Services awarded $24.1 million to C2C INNOVATIVE SOLUTIONS, INC.. TAS::75 0511::TAS MEDICARE 2ND LEVEL OF APPEALS - PART B NORTH

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 $24.1 million.

What is the period of performance?

Start: 2010-01-01. End: 2013-03-31.

What is the track record of C2C Innovative Solutions, Inc. in managing federal contracts, particularly within the healthcare sector?

Assessing the track record of C2C Innovative Solutions, Inc. requires a review of their past performance on federal contracts. While this specific contract with HHS for Medicare appeals is a significant award, understanding their broader history with agencies like CMS, or other healthcare-related entities, is crucial. Key indicators would include past performance evaluations, any contract disputes or terminations, and the types and values of previous awards. A positive track record would demonstrate their ability to consistently meet contractual obligations, manage complex projects, and deliver quality services within budget and schedule. Conversely, a history of performance issues or unresolved disputes could raise concerns about their capacity to effectively manage this current contract.

How does the $24.1 million contract value compare to similar Medicare appeals processing or administrative support contracts?

Comparing the $24.1 million contract value requires identifying comparable contracts for Medicare appeals processing or similar administrative support services within the Centers for Medicare and Medicaid Services (CMS) or other federal health agencies. Factors such as the scope of work, duration, complexity of appeals, and the specific services rendered (e.g., data analysis, case management, legal review) are critical for a meaningful comparison. If similar contracts for comparable services over a similar timeframe were awarded at a lower total cost or with a lower per-year expenditure, it might suggest that this contract's value is on the higher end. Conversely, if the scope or complexity is greater, the value might be justified. Without access to a database of comparable contract values and detailed scopes of work, a precise benchmark is difficult.

What are the primary risks associated with a Cost Plus Award Fee (CPAF) contract for Medicare appeals?

A primary risk with Cost Plus Award Fee (CPAF) contracts is the potential for cost overruns if the 'cost-plus' component is not tightly managed and the 'award fee' component is consistently maximized without stringent oversight. Contractors may have less incentive to control costs aggressively when a significant portion of their profit is tied to achieving performance targets, which can sometimes be subjective or broadly defined. For Medicare appeals, risks also include potential delays in processing, errors in adjudication, or a decline in the quality of service if performance metrics are not adequately defined or monitored. Ensuring that the award fee criteria are specific, measurable, achievable, relevant, and time-bound (SMART) is crucial to mitigate these risks and ensure value for taxpayer money.

How effective has C2C Innovative Solutions, Inc. been in meeting the performance objectives outlined in this contract?

Determining the effectiveness of C2C Innovative Solutions, Inc. in meeting performance objectives requires access to the contract's performance evaluations and award fee determinations. The Cost Plus Award Fee (CPAF) structure is designed to incentivize performance, so the extent to which the contractor achieved high award fees would indicate their effectiveness. Key performance indicators (KPIs) for Medicare appeals might include timeliness of processing, accuracy rates, reduction in backlogs, and beneficiary satisfaction. Without access to these specific performance metrics and the government's assessment of them, it is impossible to definitively state how effective the contractor has been. Publicly available contract data typically does not include this level of detail.

What has been the historical spending trend for Medicare appeals processing and administrative support services by the federal government?

Analyzing historical spending trends for Medicare appeals processing and administrative support services requires examining federal procurement data over several fiscal years. This would involve looking at contracts awarded by CMS and potentially other related agencies for similar services. Trends might show an increase in spending due to growing Medicare enrollment, increased complexity of cases, or shifts in government strategy towards outsourcing these functions. Conversely, spending might decrease if efficiencies are found, processes are streamlined, or if the government brings more functions in-house. Understanding these historical patterns provides context for the current contract's value and helps identify potential areas for cost savings or efficiency improvements in the future.

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: COST PLUS AWARD FEE (R)

Evaluated Preference: NONE

Contractor Details

Parent Company: TMF Health Quality Institute

Address: 532 RIVERSIDE AVE, JACKSONVILLE, FL, 32202

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

Financial Breakdown

Contract Ceiling: $24,140,411

Exercised Options: $24,140,411

Current Obligation: $24,140,411

Contract Characteristics

Commercial Item: COMMERCIAL PRODUCTS/SERVICES PROCEDURES NOT USED

Parent Contract

Parent Award PIID: HHSM500200400005I

IDV Type: IDC

Timeline