Amendment #2 RFP for Conducting Recovery Audit Services for the VHA Office of Finance, Department of Veterans Affairs (VA)
Closed Solicitation Posted
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- Solicitation number
- 36C10X25R0021_0002
- Agency
-
VA Strategic Acquisition Center Frederick
Headquarters, Department of Veterans Affairs
- Responses due
- Set-aside
- No set-aside
Opportunity facts
- NAICS code
- 541219 Other Accounting Services
- PSC
- R704 Support- Management: Auditing
- Place of performance
- Frederick, Maryland 21703, United States
Notice details come from SAM.gov. Updated .
About this opportunity
The Department of Veterans Affairs Strategic Acquisition Center Frederick is seeking contractors to provide Recovery Audit Services for the VHA Office of Finance, specifically to conduct audits of healthcare claim payments across various Community Care programs including preauthorized claims, emergency care, CHAMPVA, Spina Bifida, and National Dialysis Contract claims. The VA intends to award one to three fixed percentage of recovery contracts where contractors will only be compensated based on a percentage of actual overpayments recovered, requiring contractors to assume all upfront execution costs. Key requirements include establishing a secure data portal, customer service center, comprehensive audit processes with dispute management capabilities, maintaining a 95% audit accuracy rate, and completing extensive pre-implementation tasks including security documentation and obtaining Authority to Operate certification. The contract structure includes performance incentives with a 0.2% contingency fee adjustment per percentage point above or below the 95% accuracy threshold. Proposals are due September 9, 2025, following Amendment #2 which extended the original deadline.
While the solicitation indicates "No Set-Aside Used" in the posted notice, the RFP document reveals this is actually set aside for small businesses with evaluation preferences for Service-Disabled Veteran-Owned Small Businesses and Veteran-Owned Small Businesses. The current incumbent is Cotiviti Gov Services, LLC, who previously received 13.5% of identified recovered amounts as compensation. The contract will cover claim volumes ranging from 180,000 to 5.5 million claims across different programs, with total claim values spanning from $26 million to $11 billion, and will audit claims from fiscal years 2024-2029. The period of performance includes a one-year base period followed by four optional one-year extension periods for a potential total duration of five years. Performance will take place in Frederick, Maryland, and the solicitation falls under NAICS code 541219 with a $25 million size standard.
Notice text
The Department of Veterans Affairs (VA), VHA Office of Finance (OF) has a requirement for up to conduct Recovery Audit (RA) activities of healthcare claim payments made for a variety of VHA Community Care programs, as described below. Automated reviews occur at the system level while complex reviews require a qualified individual to review the medical record. Each program has specific payment methodologies as defined by VA regulations. In general, the audit will review various types of paid healthcare claim data with specific dates and criteria included in the description of each auditing scenario.
The VA intends to award one (1) but not more than three (3) FFP (fixed percentage of recovery) contract(s) to provide healthcare claims recovery auditing services. Contractor compensation under this contract will be contingent upon the accurate identification of valid overpayments and the successful recovery of those overpayments by the Government. The contractor shall assume all costs associated with the execution of RAC tasks and will only be reimbursed based on a fixed percentage of actual funds recovered.
The Period of Performance (POP) for the base period shall be from the date of award for a period of one (1) year base period, followed by four (4) year option periods to be awarded at the discretion of the Government.
Files
| File | Type | Posted |
|---|---|---|
| D.6 OFFEROR ATTESTATION OF RESPONSIBILITY.docx | DOCX document | |
| D.5 PAST PERFORMANCE QUESTIONAIRE.docx | DOCX document | |
| RFP 36C10X25R0021_0002.pdf | ||
| D.2 BAA.docx | DOCX document | |
| Amendment RFP 36C10X25R0021 0002.pdf | ||
| D.3 CONTRACTOR RULES OF BEHAVIOR.docx | DOCX document | |
| D.1 SUBCONTRACTING PLAN.docx | DOCX document | |
| D.7 QASP.docx | DOCX document | |
| D.4 APPENDIX C VA INFORMATION AND INFORMATION SYSTEM SECURITY AND PRIVACY LANGUAGE.docx | DOCX document |
Notice history
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