Amendment #2 RFP for Conducting Recovery Audit Services for the VHA Office of Finance, Department of Veterans Affairs (VA)

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.