PRESOL | D | Medicare Fraud Detection Assessment Services - Solicitation Word Document, Attachments, SF 33

FBO DAILY ISSUE OF AUGUST 28, 2010 FBO #3199
SOLICITATION NOTICE

D -- Medicare Fraud Detection Assessment Services - Solicitation Word Document, Attachments, SF 33

Notice Date: 8/26/2010
Notice Type: Combined Synopsis/Solicitation
NAICS: 541990 — All Other Professional, Scientific, and Technical Services
Contracting Office: Railroad Retirement Board, Acquisition Management Division, OA, Procurement Section, 844 North Rush Street, 9th Floor NE, Chicago, Illinois, 60611-2092
ZIP Code: 60611-2092
Solicitation Number: RRB10R004
Point of Contact: Paul T. Ahern, Phone: (312) 751-7130, Elizabeth A Kelly, Phone: 312-751-3350
E-Mail Address: paul.ahern@rrb.gov, elizabeth.kelly@rrb.gov
(paul.ahern@rrb.gov, elizabeth.kelly@rrb.gov)
Small Business Set-Aside: N/A
Description: SF 33 (Page 1 of the solicitation) Attachment B Attachment A Solicitation RRB10R004 I. This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in the Federal Acquisition Regulation (FAR) subject 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation. Offers are being requested and a written solicitation will not be issued, however Offerors either use the attached formatted solicitation document or alternatively may contact the Mr. Milt Vasich, for a copy of this solicitation in a Word document format. Mr. Vasich can be reached at (312)751- 4687 or through email at Milton.vasich@rrb.gov. Offerors may send questions regarding this solicitation by email to oigproposals@oig.rrb.gov by 11:00pm CDT on August 31, 2010. A. This solicitation is issued as a Request-For-Proposals RRB10R004. B. The solicitation document and incorporated provisions are those in effect through Federal Acquisition Circular Number 2005-44. C. This solicitation is not a small business set-aside. D. The Office of Inspector General (OIG) is a separate and independent office located within the U.S. Railroad Retirement Board (RRB). The OIG is responsible for conducting, supervising, and coordinating audits and investigations relating to the Railroad Retirement and Railroad Unemployment insurance Acts. The Office of the Inspector General is located at 844 North Rush Street in Chicago, Illinois (herein referred to as Headquarters). E. The OIG is seeking a single contractor that can review and analyze Medicare Part B claims, excluding Durable Medical Equipment (DME) claims, paid to providers on behalf of railroad retirement beneficiaries to identify potential fraudulent claims. The Contractor shall make recommendations identifying areas that should be subject to additional pre-payment review to enhance fraud detection before claims are paid. Offerors shall submit their firm fixed price offers on the Price Schedule in Section B of the attached solicitation. III. STATEMENT OF WORK. A. Background: (1) The Office of Inspector General (OIG) of the Railroad Retirement Board (RRB) is issuing this Request for Proposal (RFP) to identify fraud and abuse in the RRB's Medicare program. (2) The RRB is an independent agency in the executive branch of the Federal government. Its primary function is to administer comprehensive retirement survivor and unemployment sickness insurance benefit programs for the nation's railroad workers and their families. These programs are provided under the Railroad Retirement Act (RRA) and the Railroad Unemployment Insurance Act (RUIA). In addition, the RRB has administrative responsibilities under the Social Security Act for certain benefit payments and Medicare coverage for railroad workers. (3) The RRB contracts with Palmetto Government Benefits Administrators (GBA) to serve as the RRB Medicare carrier. Palmetto GBA processes all Medicare Part B claims, except claims associated with Durable Medical Equipment, for RRB beneficiaries. On an annual basis, Palmetto GBA processed approximately 12 million claims by 800,000 providers for 600,000 beneficiaries. (4) The RRB-OIG was established to conduct and supervise audits and investigations relating to the RRB's programs and operations. The RRB-OIG is required to provide leadership and coordination and recommend policies for activities to promote economy, efficiency, and effectiveness in the administration of and to prevent and detect fraud and abuse in the agency's programs and operations. B. Description of Services/Requirements: The OIG's audit division requires a Contractor that shall provide all services, personnel, equipment and materials necessary to perform the work described by this statement of work. 1. Claims for Services After Beneficiaries' Death - Using two but not more than four commercially available databases, one of which must be the Social Security Administration Master Death File, the Contractor shall (a) determine if the date of service relating to the Medicare Part B (excluding DME) claim occurred after the beneficiaries' date of death. The Contractor shall also (b) determine if any services were paid for or submitted more than 60 days after the beneficiaries' date of death. The RRB-OIG will provide three years of non-DME Medicare Part B claims information for this determination as described in Section C5. The Contractor shall (c) provide a list of the 100 oldest beneficiaries and provide further analysis of these beneficiaries, including, but not limited to claims history during the past three years. 2. Analysis of Potentially Fraudulent Claims - Using data provided by the RRB-OIG described in Section C5, which consists of all non-DME Medicare Part B claims paid for a three year period, Contractor will (a) analyze claims data to identify potentially fraudulent claims. Analysis should include (b) fraud patterns involving excessive diagnostic procedures or services. Contractor agrees to (c) use two or more algorithms which are approved by the RRB-OIG. 3. Communicate Results (Formal Deliverable Reports) - The Contractor shall communicate the results of its review in written reports that details the objective, scope, methodology and results of review. Any databases, algorithms, logic or code implemented in the Contractor's analysis must be described in each report in a manner sufficient to allow the RRB-OIG to duplicate the search results. The Contractor shall also provide the RRB-OIG with the computer code, logic and algorithm used in each search which the RRB-OIG agrees not to release. The Contractor shall also provide a database for each report that identifies potential fraud. Any reports identifying potential fraud must include sufficient information to allow the RRB-OIG to investigate fraudulent claims. Any deficiencies, recommendations for corrective action and/or improvement reported must be included in each report for the related review segment. Each report shall be circulated to the RRB-OIG for review and comment prior to finalization (See Section F). All reports must be submitted in Adobe Acrobat (PDF) format. (a) Report for Claims for Services After Beneficiaries' Death - (1) The Contractor shall prepare a report that identifies the type, number and date of claims for services after the beneficiaries' death. The report will include a determination of whether these claims are allowable under Federal law and regulations. (2) The Contractor shall also prepare a report that identifies the type, number and date of claims for services submitted more than 60 days after the beneficiaries' date of death. The report will include a determination of whether these claims are allowable under Federal law and regulations. (3) The Contractor shall also provide a report of the 100 oldest beneficiaries with analysis of claims history for these beneficiaries during the past three years. (b) Analysis of Potentially Fraudulent Claims - The Contractor shall prepare a report that identifies potentially fraudulent claims, rationale for identifying the claims as fraudulent and recommendations for pre-payment screening edits. The report shall, at a minimum, provide an analysis on a provider basis, claims by a particular doctor, procedure and beneficiary. 4. Government Furnished Data RRB-OIG will provide the Contractor with Railroad Medicare Part B claims data, excluding DME claims data, for the past three years in electronic media that will be in either ASCII format, or in a format that is mutually agreeable between the RRB-OIG and the Contractor. The size of the claims information provided by the RRB-OIG is three years of claims information. For each of the three years the data includes approximately 12 million claims by approximately 800,000 providers for 600,000 beneficiaries. N.B. The Contractor shall agree to comply with the Privacy Act and HIPAA at all times as set forth in Section H. The Contractor bears the risk of loss for either unauthorized release or loss of information provided by the RRB-OIG. The Contractor shall also provide a report identifying the individuals who were granted access to the information provided by the RRB-OIG, how and where the information was maintained, how the information will be returned or destroyed or removed from the Contractor's electronic systems. 5. Entrance/Exit and Other Conferences - The Contractor will contact the Contracting Officer's Technical Representative (COTR) within three (3) business days of contract award to arrange an opening conference at RRB-OIG Headquarters in Chicago, Illinois with Contractor key personnel and RRB-OIG management. A scheduling conference for project meetings shall be conducted no later than September 30, 2010. The Contractor will be prepared to discuss their overall engagement approach and project plan with responsible RRB-OIG officials. When each draft report is released to the RRB-OIG for review and comment, the Contractor will, at the request of the RRB-OIG, meet with RRB-OIG to discuss the results of the Contractor review and each report's content, prior to acceptance of the draft by the RRB-OIG. At this conference the Contractor will communicate the findings and recommendations developed during the engagement and elicit initial views from RRB-OIG officials and respond to questions about the Contractor's work leading to that report. The entrance conference will be held on site at RRB-OIG headquarters in Chicago, Illinois. The exit conferences and other conferences necessary to brief RRB-OIG management may be held either on site or via telephone. 6. Detailed Project Plan - Upon contract award the Contractor shall prepare a Project Plan that sets forth the specific approach and methodology for performing the review described in Section C that includes specific information that: (a) details the timing of major phases of the review work including major and minor milestones for planning, fieldwork and reporting phases of the project; (b)identifies the electronic data required to perform the review described in Section C3 of this solicitation; (c) describes the manner in which the Contractor will provide data security for data provided by the RRB-OIG in connection with this project; (d) includes a formal staffing plan that describes the roles for each staff member for the project; and (e) details the level of effort by RRB-OIG personnel to accomplish their roles or responsibilities under the Contract,as required for the Contractor to complete the review described in III (Section C3) of this solicitation and communicate progress and results in accordance with the requirements in this section III (Section C4) of this solicitation. (e) The project plan will include a schedule that includes the dates on which the draft and final reports required in Section C4 of this solicitation will be delivered. 7.Progress Meetings and Reports - The Contractor shall submit Monthly oral progress reports (with a written summary) to the designated RRB-OIG management officials on the first business day of each month beginning with the month after contract award. The reports will provide (a) progress to date compared with the project plan and time schedule; (b) any issues that could impact the progress or outcome of the Contractor's work; and (c) matters that have come to the Contractor's attention that could impact the results of the reports required in Section C3. 8. Confidentiality - All work performed under this contract is confidential and is not to be released to outside parties without express written permission from the Contracting Officer. IV. CONTRACT CLAUSES. The following FAR clauses are incorporated by reference: 52.202 1, Definitions, Jul 2004, 52.203 3, Gratuities, Apr 1984, 52.203 5, Covenant Against Contingent Fees, Apr 1984, 52.203 6, Restrictions on Subcontractor Sales to the Government, Sep 2006, 52.203 7, Anti Kickback Procedures, Jul 1995, 52.203 8, Cancellation, Rescission, and Recovery of Funds for Illegal Improper Activity, Jan 1997, 52.203 10, Price or Fee Adjustment for Illegal or Improper Activity, Jan 1997, 52.203 12, Limitation on Payments to Influence Certain Federal Transactions, Sep 2007, 52.204 2, Security Requirements, Aug 1996 52.204 4, Printed or Copied Double Sided on Recycled Paper, Aug 2000, 52.204 6 Data Universal Numbering System (DUNS)) Number., Apr 2008, 52.204 9, Personal Identify Verification of Contractor Personnel, Sep 2007 52.208 9, Contractor Use of Mandatory Sources of Supply or Services, Oct 2008, 52.209 6, Protecting the Government's Interest when Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment, Sep 2006 52.214 34, Submission of Offers in the English Language, Apr 1991, 52.215 2, Audit and Record - Negotiation, Mar 2009, 52.215 8, Order of Preference Universal Contract Format, Oct 1997, 52.219 8, Utilization of Small Business Concerns, May 2004, 52.222 3, Convict Labor, Jun 2003, 52.222 21, Prohibition of Segregated Facilities, Feb 1999, 52.222 26, Equal Opportunity, Mar 2007, 52.222 35, Equal Opportunity for Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans., Sep 2006, 52.222 36, Affirmative Action for Workers with Disabilities, Jun 1998, 52.222 37, Employment Reports on Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans, Sep 2006, 52.222 41, Service Contract Act, Nov 2007, 52.222 43, Fair Labor Standards Act & Service Contract Act, Nov 2006, 52.223 6, Drug Free Workplace, May 2001, 52.225 13, Restrictions on Certain Foreign Purchases, Jun 2008, 52.229 3, Federal, State, and Local Taxes, Apr 2003 52.232 1, Payments, Apr 1984, 52.232 8, Discounts for Prompt Payment, Feb 2002, 52.232 11, Extras, Apr 1984 52.232 17, Interest, Oct 2008, 52.232 23, Assignment of Claims, Jan 1986, 52.232 25, Prompt Payment, Oct 2008 52.232 33, Payment by Electronic Funds Transfer Central Contractor Registration, Oct 2003, 52.233 1, Disputes, Jul 2002, 52.233 3, Protest after Award, Aug 1996, 52.233 4, Applicable Law for Breach of Contract Claim, Oct 2004, 52.239 1, Privacy or Security Safeguards, Aug 1996, 52.242 2, Production Progress Reports, Apr 1991 52.242 13, Bankruptcy, Jul 1995, 52.243 1, Changes Fixed Price, Aug 1987, 52.244 2, Subcontracts, Jun 2007 52.244 6, Subcontracts for Commercial Items, Mar 2009, 52.246 20, Warranty of Services, May 2001 52.246 25, Limitation of Liability - Services, Feb 1997, 52.248 1, Value Engineering, Feb 2000, 52.249 4, Termination for Convenience of the Government (Services) (Short Form), Apr 1984, 52.249 8, Default (Fixed Price Supply and Service), Apr 1984, 52.251 1, Government Supply Sources, Apr 1984, 52.253 1, Computer Generated Forms, Jan 1991, 52.204 1, Approval of Contract (December 1989), 52.204 7 CENTRAL CONTRACTOR REGISTRATION (APRIL 2008), V.IMPORTANT INFORMATION. A. PRIVACY ACT NOTIFICATION (APR 1984) FAR 52.224-1.The Contractor will be required to design, develop, or operate a system of records on individuals, to accomplish an agency function subject to the Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Violation of the Act may involve the imposition of criminal penalties. B. PRIVACY ACT (APR 1984) FAR 52.224-2. 1. The Contractor agrees to - a. Comply with the Privacy Act of 1974 (the Act) and the agency rules and regulations issued under the Act in the design, development, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies: (i). The systems of records; and (ii) The design, development, or operation work that the contractor is to perform. b. Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every subcontract awarded without a solicitation, when the work statement in the proposed subcontract requires the redesign, development, or operation of a system of records on individuals that is subject to the Act; and, c. Include this clause, including this subparagraph (c), in all subcontracts awarded under this contract which requires the design, development, or operation of such a system of records. 2. In the event of violations of the Act, a civil action may be brought against the agency involved when the violation concerns the design, development, or operation of a system of records on individuals to accomplish an agency function, and criminal penalties may be imposed upon the officers or employees of the agency when the violation concerns the operation of a system of records on individuals to accomplish an agency function. For purposes of the Act, when the contract is for the operation of a system of records on individuals to accomplish an agency function, the Contractor is considered to be an employee of the agency. 3. a. "Operation of a system of records," as used in this clause, means performance of any of the activities associated with maintaining the system of records, including the collection, use, and dissemination of records. b. "Record," as used in this clause, means any item, collection, or grouping of information about an individual that is maintained by an agency, including, but not limited to, education, financial transactions, medical history, and criminal or employment history and that contains the person's name, or the identifying number, symbol, or other identifying particular assigned to the individual, such as a fingerprint or voiceprint or a photograph. c. "System of records on individuals," as used in this clause, means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual. D. Post-award conference: In order to codify the implementation and procedural issues attendant upon contract performance, a post-award conference will be held at the RRB headquarters facility in Chicago, IL no later than ten calendar days after contract award. The Contractor must attend this conference and be prepared to discuss the project milestone events and schedule. The Contractor will be responsible for all costs related to attending this conference. E. Billing: Contractor shall submit invoices with quantities for work completed and pricing as designated in Sections B and G2 and G3 indicating deliverables provided and dates. VI.SUBMISSION OF QUOTATIONS/PROPOSAL. A. FAR Provision 52.215-1, Instructions to Offerors, applies to this acquisition and is hereby included by reference. B. The offeror must submit two (2) signed and dated offers to the office specified in this solicitation by 11:00 a.m. CDT on September 10, 2010. Offerors Are Strongly encouraged to submit their proposals (in 2 separate volumes Business and Technical) in an electronic version via email to OIGproposals@oig.rrb.gov. Offers must be submitted on the SF 33 (Attached). Offerors must complete the price schedule (RFP Section B) as well as required certifications. C. Past Performance: The Offeror should provide information on previously performed contracts or ongoing contracts that are similar to the requirements as stated in the statement of work (section III) performed for Federal, State or local Government and for commercial firms. Information shall be provided on either: 1. All such contracts within the past eighteen months or, 2. The last three such contracts performed, whichever is fewer, and shall be limited to the name and address of the organization for which the services were performed and the phone numbers of at least two knowledgeable technical contacts for each contract listed. The offeror shall provide information on problems encountered on similar contracts, corrective actions taken to resolve those problems. The proposal should not describe past performance history in the contract. D. The offeror must provide a detailed narrative, including charts, tables and other illustrations as needed to explain their proposed approach solution and offeror's ability to meet the requirements in section III. above. E. In addition, the offeror must include in the proposal submission the following: The certifications required at Attachment B and at FAR 52.204-8 Annual Representations and Certifications. VII. EVALUATION AND AWARD. A. The ratio of technical to price factors shall be 2:1. B. Technical Evaluation Factors: The following evaluation factors are shown below in descending order of importance: 1.Understanding of the OIG Requirements and Project Scope, 2. Experience and Qualifications of Proposed Staff, 3. Experience of the Firm, 4. Technical Approach and Project Plan, 5. Past Performance, and 6. Quality Control and Data Security. C. The Technical Score shall be the sum of all awarded points for each evaluated factor listed above and the subfactors listed in the RFP. D. Calculation of the Price Score will be computed by multiplying the maximum point score available by a fraction representing the ration of the lowest total evaluated price of all technically acceptable offers received to the total evaluated price of the offer being evaluated. E. Award and determination will be made based on a best value basis and the total evaluated price with technical factors considered as outlined above and following procedures in the FAR subpart 15.304 and 15.305. F. A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer's specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award. Negotiation conducted after receipt of an offer does not constitute a rejection or counteroffer by the Government.
Web Link: FBO.gov Permalink
(https://www.fbo.gov/spg/RRB/BSS/PD/RRB10R004/listing.html)
Place of Performance: Address: 844 N. Rush St, Chicago, Illinois, 60611, United States; Zip Code: 60611
Record: SN02255850-W 20100828/100826235627-95c607687ab2411f23c2d98389fb735d (fbodaily.com)
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D -- Medicare Fraud Detection Assessment Services - Solicitation Word Document, Attachments, SF 33