HHS awarded $33.6M for Medicare Part A appeals, with Maximus Federal Services handling 5 delivery orders

Contract Overview

Contract Amount: $33,559,673 ($33.6M)

Contractor: Maximus Federal Services, Inc.

Awarding Agency: Department of Health and Human Services

Start Date: 2009-05-14

End Date: 2012-02-13

Contract Duration: 1,005 days

Daily Burn Rate: $33.4K/day

Competition Type: COMPETITIVE DELIVERY ORDER

Number of Offers Received: 5

Pricing Type: FIRM FIXED PRICE

Sector: Healthcare

Official Description: MEDICARE PART A EAST 2ND LEVEL APPEALS

Place of Performance

Location: RESTON, FAIRFAX County, VIRGINIA, 20190

State: Virginia Government Spending

Plain-Language Summary

Department of Health and Human Services obligated $33.6 million to MAXIMUS FEDERAL SERVICES, INC. for work described as: MEDICARE PART A EAST 2ND LEVEL APPEALS Key points: 1. Value for money appears fair, given the fixed-price nature and duration of the contract. 2. Competition dynamics indicate a competitive award, suggesting potential for price discovery. 3. Risk indicators are moderate, with a fixed-price contract mitigating cost overrun risks. 4. Performance context is within administrative management and consulting services. 5. Sector positioning is within healthcare administration, specifically Medicare appeals processing.

Value Assessment

Rating: fair

The total award of $33.6 million for Medicare Part A appeals processing over approximately three years suggests a moderate per-year expenditure. Benchmarking against similar administrative support contracts for federal health programs is challenging without more granular data on the scope of services. However, the fixed-price contract type provides a degree of cost certainty for the government. The number of delivery orders (5) indicates a structured approach to tasking within the larger contract.

Cost Per Unit: N/A

Competition Analysis

Competition Level: full-and-open

This contract was awarded as a competitive delivery order, suggesting it was part of a larger indefinite-delivery/indefinite-quantity (IDIQ) contract or a similar competitive vehicle. The fact that it was competed indicates that multiple vendors had the opportunity to bid. The presence of 5 delivery orders suggests a sustained need for these services over the contract period.

Taxpayer Impact: A competitive award process generally benefits taxpayers by fostering price competition and encouraging vendors to offer their best pricing to secure the business.

Public Impact

Beneficiaries of Medicare Part A who require appeals for denied claims are directly impacted by the efficient processing of these cases. The services delivered include administrative management and general management consulting related to the appeals process. The geographic impact is national, as Medicare is a federal program, though specific operational locations for Maximus are not detailed here. Workforce implications include employment opportunities within Maximus for administrative and support staff involved in processing appeals.

Waste & Efficiency Indicators

Waste Risk Score: 50 / 10

Warning Flags

Potential for scope creep if appeals volume significantly exceeds projections.
Dependence on contractor performance for timely and accurate appeals resolution.
Ensuring consistent application of policy across all appeals processed.

Positive Signals

Fixed-price contract structure limits financial risk for the government.
Competitive award process suggests a market-driven price.
Multiple delivery orders indicate a structured and managed relationship.

Sector Analysis

This contract falls within the broader healthcare administration and IT services sector, specifically focusing on the operational aspects of managing federal health insurance programs. The market for such services is substantial, driven by the complexity and scale of government healthcare initiatives like Medicare. Comparable spending benchmarks would typically be found within other contracts awarded by CMS for claims processing, appeals, or related administrative functions.

Small Business Impact

Information regarding small business set-asides or subcontracting plans for this specific contract is not provided in the data. As a competitive award, it's possible that large businesses were the primary bidders, but subcontracting opportunities could have existed. Further analysis would be needed to determine the extent of small business participation.

Oversight & Accountability

Oversight would typically be managed by the Centers for Medicare and Medicaid Services (CMS) contracting officers and program managers. Accountability measures are inherent in the fixed-price contract terms and performance expectations. Transparency is generally facilitated through federal procurement databases like FPDS, where contract awards are reported.

Related Government Programs

Medicare Part B Appeals
Medicaid Appeals Processing
Federal Health Claims Adjudication
Administrative Support Services for Federal Agencies
Management Consulting for Healthcare Providers

Risk Flags

Contract Duration
Potential for Scope Creep
Performance Monitoring

Frequently Asked Questions

What is this federal contract paying for?

Department of Health and Human Services awarded $33.6 million to MAXIMUS FEDERAL SERVICES, INC.. MEDICARE PART A EAST 2ND LEVEL APPEALS

Who is the contractor on this award?

The obligated recipient is MAXIMUS FEDERAL SERVICES, 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 $33.6 million.

What is the period of performance?

Start: 2009-05-14. End: 2012-02-13.

What was the specific nature of the administrative management and general management consulting services provided under this contract?

The contract data indicates the service category as 'Administrative Management and General Management Consulting Services' (NAICS 541611). For Medicare Part A appeals, this typically involves the processing of beneficiary appeals for denied claims. Services would likely include intake of appeal requests, review of documentation, application of Medicare regulations and policies, communication with beneficiaries and providers, and documentation of decisions. General management consulting aspects might involve process improvement recommendations for the appeals workflow or system utilization advice.

How does the total award amount of $33.6 million compare to other similar Medicare appeals processing contracts?

Direct comparison of the total award amount ($33.6 million) to other similar Medicare appeals contracts requires access to a broader dataset of federal procurements. However, considering the contract duration of approximately three years (from May 2009 to February 2012), the annual expenditure averaged around $11.2 million. This figure needs to be contextualized by the volume of appeals processed, the complexity of cases, and the specific services required. Without detailed performance metrics and scope comparisons, it's difficult to definitively state if this represents high or low spending relative to benchmarks.

What were the key performance indicators (KPIs) used to evaluate Maximus Federal Services' performance on this contract?

The provided data does not specify the Key Performance Indicators (KPIs) for this contract. However, for Medicare appeals processing, typical KPIs would likely include metrics such as timeliness of appeal resolution (e.g., average days to process an appeal), accuracy of decisions (measured by overturn rates or quality reviews), beneficiary satisfaction, and adherence to regulatory requirements. Contractual terms would outline specific performance standards and potential remedies for non-performance.

What is the track record of Maximus Federal Services in handling large federal healthcare contracts, particularly those involving sensitive data like Medicare claims?

Maximus Federal Services, Inc. is a well-established government contractor with extensive experience in administering federal and state health and human services programs. They have a long history of managing large-scale contracts for agencies like CMS, the Social Security Administration, and various state Medicaid agencies. Their portfolio often includes eligibility determination, call center operations, claims processing, and appeals management. While specific performance details for every contract are not publicly available, their continued success in winning and performing on numerous large federal contracts suggests a generally positive track record in handling complex programs and sensitive data.

Were there any significant challenges or disputes encountered during the performance of this contract?

The provided contract data does not contain information regarding specific challenges, disputes, or contract modifications beyond the initial award and delivery orders. Federal contract performance databases sometimes contain details on contract disputes, claims, or significant modifications, but this level of detail is not present in the summary data. Generally, large contracts can encounter issues related to scope adjustments, performance disagreements, or funding changes, but without specific reporting, it's impossible to confirm for this instance.

How has federal spending on Medicare appeals processing evolved since the completion of this contract in 2012?

Federal spending on Medicare appeals processing has likely evolved significantly since 2012 due to changes in healthcare policy, legislative mandates (such as the Affordable Care Act), and increasing healthcare utilization. While this specific contract concluded, CMS continues to procure services for managing Medicare appeals. Spending trends are influenced by factors like the volume of claims, the complexity of appeals, the introduction of new regulations, and the efficiency of processing methods, including the use of technology and contractor support. Overall healthcare spending has trended upwards, and it's reasonable to assume spending on related administrative functions like appeals has also seen fluctuations and potential increases.

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: COMPETITIVE DELIVERY ORDER

Solicitation Procedures: NEGOTIATED PROPOSAL/QUOTE

Offers Received: 5

Pricing Type: FIRM FIXED PRICE (J)

Evaluated Preference: NONE

Contractor Details

Parent Company: Maximus Inc (UEI: 082347477)

Address: 11419 SUNSET HILLS ROAD, RESTON, VA, 20190

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

Financial Breakdown

Contract Ceiling: $35,728,466

Exercised Options: $33,559,673

Current Obligation: $33,559,673

Contract Characteristics

Commercial Item: COMMERCIAL ITEM PROCEDURES NOT USED

Parent Contract

Parent Award PIID: HHSM500200400007I

IDV Type: IDC

Timeline