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GAO Sustains TRICARE Protest On Multiple Grounds

Client Alert | 1 min read | 11.18.09

In Health Net Fed Servs., Inc. (Nov. 4, 2009), GAO sustained the protest of Health Net (represented by C&M) against a $16 billion TRICARE award because (1) the agency's past performance evaluation unreasonably gave the awardee significant credit for contracts much smaller than the contract to be awarded and improperly attributed to the awardee the past performance of the awardee's parent and its affiliates; (2) the agency's price realism evaluation failed to consider whether the awardee's staffing reflected a lack of understanding of the technical requirements; (3) the agency overlooked the risk associated with the awardee's proposed plan to hire large percentages of the incumbent workforce; and (4) the agency did not consider, as part of the technical evaluation, the cost savings associated with the protester's proposed approach. In addition to the fatal evaluation errors, GAO also determined that the awardee's use of a former high-level government employee in preparing its proposal created an appearance of impropriety based on the unfair competitive advantage stemming from the individual's earlier access to non-public, proprietary, and source-selection-sensitive information.

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Client Alert | 2 min read | 02.03.26

CMS Doubles Down on RADV Audit Changes

On January 27, 2026, the Centers for Medicare and Medicaid Services (CMS) released a Health Plan Management System (HPMS) memo that provided a long-awaited update on how the agency plans to approach previously announced Risk Adjustment Data Validation (RADV) audits for Payment Years (PY) 2020-2024. The memo is the agency’s most comprehensive statement on the subject since September 25, 2025, when the Northern District of Texas vacated the 2023 RADV Final Rule. The memo makes clear that, while CMS has made certain operational adjustments in response to concerns expressed by Medicare Advantage Organizations (MAOs), the agency is largely pressing forward with the accelerated audit strategy announced in May 2025....