HHS awards $24.1M for medical review accuracy, with RELI GROUP INC securing the contract
Contract Overview
Contract Amount: $24,129,486 ($24.1M)
Contractor: Reli Group Inc
Awarding Agency: Department of Health and Human Services
Start Date: 2018-08-02
End Date: 2023-11-26
Contract Duration: 1,942 days
Daily Burn Rate: $12.4K/day
Competition Type: FULL AND OPEN COMPETITION AFTER EXCLUSION OF SOURCES
Number of Offers Received: 3
Pricing Type: FIRM FIXED PRICE
Sector: Healthcare
Official Description: MEDICAL REVIEW ACCURACY CONTRACTOR PERFORMS ACCURACY REVIEWS ON MEDICAL REVIEW CONTRACTORS' WORK.
Place of Performance
Location: CATONSVILLE, BALTIMORE County, MARYLAND, 21228
State: Maryland Government Spending
Plain-Language Summary
Department of Health and Human Services obligated $24.1 million to RELI GROUP INC for work described as: MEDICAL REVIEW ACCURACY CONTRACTOR PERFORMS ACCURACY REVIEWS ON MEDICAL REVIEW CONTRACTORS' WORK. Key points: 1. The contract focuses on ensuring accuracy in medical reviews, a critical function for Medicare and Medicaid. 2. RELI GROUP INC is the sole awardee, raising questions about competition. 3. The contract value is substantial, necessitating careful oversight of performance and cost. 4. The sector involves healthcare administration and insurance, with significant taxpayer implications.
Value Assessment
Rating: good
The contract value of $24.1M over approximately 5 years suggests a significant investment. Benchmarking against similar contracts for accuracy reviews in healthcare administration would be necessary for a precise assessment, but the duration and scope appear reasonable for the services rendered.
Cost Per Unit: N/A
Competition Analysis
Competition Level: limited
The contract was awarded under 'FULL AND OPEN COMPETITION AFTER EXCLUSION OF SOURCES,' indicating a limited competition. This method may have impacted price discovery, potentially leading to higher costs than a fully open process.
Taxpayer Impact: The $24.1M awarded represents taxpayer funds allocated to ensure the integrity of healthcare programs. The effectiveness of the reviews will determine the ultimate value for taxpayers.
Public Impact
Ensures accuracy in medical reviews, potentially saving Medicare/Medicaid significant funds by identifying errors. Supports the operational integrity of Centers for Medicare and Medicaid Services (CMS). Impacts beneficiaries by ensuring fair and accurate processing of medical claims and services. The contract's success is tied to the quality and timeliness of the accuracy reviews performed.
Waste & Efficiency Indicators
Waste Risk Score: 50 / 10
Warning Flags
- Limited competition may have inflated costs.
- Contract duration is long, increasing risk of cost overruns or performance degradation.
- Lack of small business participation noted.
Positive Signals
- Firm Fixed Price contract type helps control costs.
- Focus on accuracy reviews is crucial for program integrity.
- Long-term contract provides stability for essential services.
Sector Analysis
This contract falls within the healthcare administration and insurance sector, specifically focusing on third-party administration and quality assurance. Spending in this area is significant due to the scale of Medicare and Medicaid programs.
Small Business Impact
The data indicates that small businesses were not involved in this contract, as the 'sb' field is false. Opportunities for small businesses in this sector are often in specialized support roles or subcontracting.
Oversight & Accountability
The contract is managed by the Centers for Medicare and Medicaid Services (CMS), a key agency within HHS. Oversight would involve monitoring performance metrics, ensuring adherence to contract terms, and managing payments to RELI GROUP INC.
Related Government Programs
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
- Department of Health and Human Services Contracting
- Centers for Medicare and Medicaid Services Programs
Risk Flags
- Potential for cost overruns due to long contract duration.
- Risk of vendor lock-in due to limited competition.
- Performance degradation over time if not actively managed.
- Lack of transparency in the 'exclusion of sources' justification.
- No small business participation.
Tags
pharmacy-benefit-management-and-other-th, department-of-health-and-human-services, md, definitive-contract, 10m-plus
Frequently Asked Questions
What is this federal contract paying for?
Department of Health and Human Services awarded $24.1 million to RELI GROUP INC. MEDICAL REVIEW ACCURACY CONTRACTOR PERFORMS ACCURACY REVIEWS ON MEDICAL REVIEW CONTRACTORS' WORK.
Who is the contractor on this award?
The obligated recipient is RELI GROUP 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: 2018-08-02. End: 2023-11-26.
What specific metrics are used to evaluate the accuracy reviews performed by RELI GROUP INC, and how do these metrics ensure value for money?
The contract likely specifies key performance indicators (KPIs) related to the accuracy and timeliness of the reviews. These could include error detection rates, reviewer efficiency, and client satisfaction. Robust metrics ensure that RELI GROUP INC is meeting its obligations and that the $24.1M investment is yielding tangible benefits in program integrity and cost savings for CMS.
Given the limited competition, what steps has CMS taken to ensure that RELI GROUP INC's pricing is fair and reasonable?
While the contract type is Firm Fixed Price, the 'limited' competition suggests that CMS may have relied on pre-negotiated rates, historical pricing data, or independent cost analysis to establish a fair price. The exclusion of sources implies a justification was made, and the agency should have ensured the proposed price was competitive within the constrained market.
How does the performance of these accuracy reviews directly contribute to the overall effectiveness and efficiency of Medicare and Medicaid programs?
By verifying the accuracy of medical reviews conducted by other contractors, this contract acts as a crucial quality control layer. It helps identify and rectify errors in claims processing, coding, and medical necessity determinations. This directly enhances the effectiveness of program operations, reduces improper payments, and ensures beneficiaries receive appropriate care, thereby improving overall program efficiency.
Industry Classification
NAICS: Finance and Insurance › Agencies, Brokerages, and Other Insurance Related Activities › Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
Product/Service Code: SUPPORT SVCS (PROF, ADMIN, MGMT) › PROFESSIONAL SERVICES
Competition & Pricing
Extent Competed: FULL AND OPEN COMPETITION AFTER EXCLUSION OF SOURCES
Solicitation Procedures: NEGOTIATED PROPOSAL/QUOTE
Solicitation ID: 75FCMC18R0013
Offers Received: 3
Pricing Type: FIRM FIXED PRICE (J)
Evaluated Preference: NONE
Contractor Details
Address: 5520 RESEARCH PARK DRIVE, SUITE 105, CATONSVILLE, MD, 21228
Business Categories: 8(a) Program Participant, Category Business, Corporate Entity Not Tax Exempt, HUBZone Firm, Minority Owned Business, Self-Certified Small Disadvantaged Business, Small Business, Special Designations, Subchapter S Corporation, Indian (Subcontinent) American Owned Business, U.S.-Owned Business
Financial Breakdown
Contract Ceiling: $24,840,810
Exercised Options: $24,129,486
Current Obligation: $24,129,486
Actual Outlays: $11,843,988
Subaward Activity
Number of Subawards: 1
Total Subaward Amount: $10,020,603
Contract Characteristics
Commercial Item: COMMERCIAL PRODUCTS/SERVICES PROCEDURES NOT USED
Cost or Pricing Data: NO
Timeline
Start Date: 2018-08-02
Current End Date: 2023-11-26
Potential End Date: 2023-11-26 00:00:00
Last Modified: 2025-01-02
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