PGBA, LLC v. United States

TRICARE Management Activity (TMA) (defendant), issued a request for proposals (RFP) to provide claims-processing services to military dependents and retired servicemembers who were dual-eligible for TRICARE and Medicare under the TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC). The RFP stated that proposals would be evaluated on three, equally weighted factors: (1) technical merit, including claims processing and data access; (2) past performance; and (3) cost. PGBA, LLC (plaintiff) and Wisconsin Physicians Service Insurance Corporation (WPS) both submitted responsive proposals. PGBA and WPS had the opportunity to submit revised, final proposals after discussions with TMA held following submission of the initial proposals. In response to feedback from TMA, PGBA revised its final proposal to specifically state how many government employees would have access to PGBA’s beneficiary claim processing data. TMA evaluated the final proposals in a multi-stage process, including a price/cost analysis. WPS submitted a higher cost proposal than PGBA did. In the evaluation, TMA (a) penalized PGBA for the specificity of its data-access plan; (b) rated PGBA and WPS equally on the claims-processing subfactor; (c) mistakenly calculated how much WPS would be able to recoup from cross-over fees paid to Medicare; and (d) determined that WPS’s higher cost was justified by its greater technical merit. TMA awarded the TDEFIC contract to WPS. PGBA filed a post-award bid challenge in the Court of Federal Claims seeking injunctive relief. By that time, the TDEFIC procurement process had been underway for approximately 18 months.