Recovery audit contractor region 5
Active Definitive Contract Awarded Last action
- Contract number
- 75FCMC25CJ008
- Awardee
-
Cotiviti GOV Services, LLC UEI MQL5DMJGJJL5
- Awarding agency
-
Centers for Medicare and Medicaid Services
Department of Health and Human Services
- Obligated
- $3,908,792
Award facts
- Opportunity
-
- Recovery Audit Contractor (RAC) Regions 3, 4, & 5 Solicitation · 75FCMC25RJ003 · Posted Nov 22, 2024
- Contract value 10% obligated
-
- $3,908,792.14 Current, with exercised options
- $39,908,792.14 Potential, with all options
- Completion date 15% complete
-
- Current, with exercised options
- Potential, with all options
- NAICS code
- 561440 Collection Agencies
- PSC
- R704 Support- Management: Auditing
- Set-aside
- No set-aside
- Competition
- Full and Open Competition · 3 offers Negotiated Proposal / Quote
- Pricing
- Firm Fixed Price
- Place of performance
- Riverton, UT 84095, USA
- Legislative mandates
-
- Service Contract Act FAR subpart 22.10
- Employment Eligibility Verification (E-Verify) FAR subpart 22.18
- Service Contract Inventory FAR subpart 4.17
Award details come from SAM.gov/FPDS.
Transactions
| Action | Obligated | Date |
|---|---|---|
| Other Administrative Action | $0 | |
| Other Administrative Action | $0 | |
| Other Administrative Action | $0 | |
| Original award | $3,908,792 |
About this award
The Centers for Medicare and Medicaid Services (CMS) awarded a Recovery Audit Contractor (RAC) Region 5 definitive contract to Cotiviti GOV Services, LLC (doing business as HMS Federal) on May 1, 2025, with a ceiling value of $39.9 million and performance extending through April 30, 2035. This firm-fixed-price contract requires the contractor to review Medicare Fee-for-Service claims submitted to Medicare Administrative Contractors in Region 5, specifically focusing on Durable Medical Equipment, Prosthetics, Orthotics, and Supply claims, as well as Home Health and Hospice claims, to identify and correct improper payments, including both overpayments and underpayments. The contractor must maintain a Joint Operating Agreement with Medicare contractors, operate a RAC Data Warehouse with monthly reporting capabilities, and support appeals through the Administrative Law Judge level while maintaining a 95% accuracy rate. Compensation is contingency-based, with payment derived solely from recovered overpayments after claims successfully exit the second level of appeals or pass the 120-day provider appeal window.
This award does not utilize a small business set-aside designation and reflects CMS's continued reliance on Cotiviti GOV Services, which currently holds multiple RAC contracts totaling approximately $240.8 million in combined ceiling values across Regions 3, 4, and 5. The contractor, headquartered in South Jordan, Utah, will perform work from its Riverton, Utah location and brings extensive expertise in healthcare analytics, claims review, and fraud detection to support the integrity of Medicare's Fee-for-Service program. The contract represents one component of CMS's broader program integrity efforts to identify and recover improper payments across the federal healthcare system.
Quick answers
Who was awarded contract 75FCMC25CJ008?
75FCMC25CJ008 was awarded to Cotiviti GOV Services, LLC by Centers for Medicare and Medicaid Services (Department of Health and Human Services) on May 1, 2025.
How much is contract 75FCMC25CJ008 worth?
The government has obligated $3,908,792 on 75FCMC25CJ008. Its potential value, with all options, is $39,908,792.
Was contract 75FCMC25CJ008 competed?
The extent of competition for 75FCMC25CJ008 was full and open competition. The government received 3 offers.
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