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Tag: medicare

Maximus announces feds have backed off $6.6B contract rebid

Editor’s Note: This story has been updated to correct an error in the original version, which incorrectly stated that the contract, not the rebidding process, had been canceled.

Tysons-based Maximus, a government contractor specializing in administrative support for Medicare and Medicaid, announced Tuesday that the U.S. Department of Health and Human Services has canceled efforts to rebid the company’s $6.6 billion contract to operate a customer service call center for the Centers for Medicare and Medicaid.

The contract, awarded by the Biden administration to Maximus in 2022 with a one-year base period, included nine one-year option periods until 2031 and covered staffing of the Contact Center Operations call center for CMS programs like 1-800 MEDICARE and the health insurance marketplace.

However, in December 2023, U.S. Department of Health and Human Services Secretary Xavier Becerra and Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure announced they would send the contract out for rebidding in an apparent response to walkouts by call center workers. The Communications Workers of America union, which had been trying to unionize Maximus’ call center workers, praised the move. U.S. Rep. Rosa DeLauro, D-Connecticut, who had criticized Maximus in 2019 for paying call center workers at low levels for federal grade workers, also expressed happiness that the contract was being re-competed.

On Nov. 1, Maximus announced it had filed a lawsuit in the U.S. Court of Federal Claims, alleging that the CMS has illegally added a “labor harmony” agreement into the rebidding process for the $6.6 billion contract started in the spring, which the company calls “baseless and unlawful” in a news release.

“Despite providing high-quality customer service, exceeding every performance metric and delivering uninterrupted service even during two hurricanes, CMS is taking the unnecessary step of rebidding the contract only two years into the nine-year term with a requirement for a labor harmony agreement,” the company said in its Nov. 1 statement. “This unprecedented move is illegal and improper pursuant to established law, regulation and procurement policy, and may jeopardize future seamless service to the 75 million Americans with Medicare and accessing health insurance through the federal marketplace all while increasing cost to taxpayers.”

The U.S. Health and Human Services’ decision to cancel the rebidding process is a win for the Tysons company.

Maximus has been the prime contractor for the 1-800 MEDICARE and health insurance marketplace contact centers since 2018 and has supported CMS contact centers for more than a decade, starting as a subcontractor to Reston-based General Dynamics. The company, which employed nearly 40,000 people as of 2023, operates 84 contact centers in 28 states and employs more than 20,000 contact center agents. It handles more than 100 million contacts per year, according to a CMS news release. Maximus reported $5.3 billion in revenue for fiscal 2024, up from $4.9 billion from the previous year.

“Maximus employees have consistently demonstrated their ability to successfully manage this critical program providing essential support to more than 75 million eligible Americans who rely on Medicare and the Federal Marketplace. We appreciate the opportunity to continue supporting HHS and CMS in their vital missions and look forward to delivering innovative, high-quality and reliable solutions that benefit the American public,” Maximus President and CEO Bruce Caswell said in a statement Tuesday.

At 4:30 p.m. Tuesday, just after Maximus’ announcement, its stock dropped from $74.99 a share to $66.80, but rebounded to $72.90 a share at closing.

The U.S. Department of Health and Human Services did not respond immediately to a request for comment Tuesday.

Bon Secours, Anthem reach agreement in $93M dispute

Bon Secours announced Friday it has reached an agreement with Anthem Blue Cross and Blue Shield in Virginia, which the health system sued in August, alleging the insurer owed Bon Secours $93 million in unpaid claims.

Although details were not released due to confidentiality agreements between the two parties, Bon Secours said it will drop the lawsuit, which was filed in Henrico County Circuit Court, and all Anthem Medicare Advantage and Medicaid health plan members will again have in-network coverage at Bon Secours. The agreement also extends coverage for employer-based Anthem customers and Affordable Care Act plan members until 2028.

“I’m proud that both organizations continued to focus on our shared priority: the communities we serve,” Anthem Virginia President Monica Schmude said in a statement. “We worked together to creatively address affordability for our members and the financial needs of an important care provider. This agreement provides long-term stable access to care at Bon Secours without cost increases for our members and employers.”

Anthem agreed to cover any claims that Medicare patients incurred at Bon Secours facilities since Aug. 1, when the health system was out of network.

“We understand that being out of network/potentially being out of network can be very difficult, and we are pleased that patients with Anthem insurance can now see our physicians and use our hospitals at an in-network cost,” Mike Lutes, president of Bon Secours Richmond, said in a statement. “We sincerely believe that access to quality health care services is vital for our communities. This new agreement protects our patients’ access to compassionate care close to home.”

The agreement also prevented Bon Secours from being out of network for Medicaid patients, which would have occurred Oct. 1 absent a deal.

In April, Winchester-based Valley Health and Anthem  settled a $15 million lawsuit filed by Valley Health over unpaid reimbursements. The terms of that settlement also were confidential.

On June 28, Anthem paid $300,000 to settle a finding from the State Corporation Commission’s Bureau of Insurance that it was not paying claims within the 40-day requirement. State regulators found that Anthem did not pay 347 claims of the 67,000 it received from December 2022 to February 2023 within the 40-day timeframe.

Bon Secours has 10 hospitals in the Richmond area and Hampton Roads and has more than 14,000 employees, including 820 physicians, according to the complaint.

Anthem, owned by Elevance Health, is the largest health insurance carrier in Virginia. Elevance reported $156 billion in total revenue for 2022, with net income of $6 billion.

The Hilb Group acquires Medicare-focused firm, six Va. companies

Henrico-County based insurance company The Hilb Group LLC finalized its acquisition of Health Quote of Rhode Island Inc. on July 1, it announced Tuesday.

Financial terms of the transaction were not disclosed.

Health Quote specializes in Medicare offerings, and its clientele will join THG’s Medicare practice.

THG CEO Ricky Spiro said in a statement, “Our strategic approach to growth is focused on continuing to build on the services and expertise that we bring to our customers. We are pleased to expand our Medicare business and offerings, as we see tremendous opportunity here for the future, and we know that we can have a positive impact in the lives of those we serve.”

The company has been focused on acquisitions in recent years and announced four in April.

The group also recently announced several acquisitions in Virginia that became effective on July 1. They include:

  • Mechanicsville-based Easley Hedrick Insurance & Financial
  • Salem-based Ryan Harris Insurance and Financial Services Inc.
  • Roanoke-based Keith Ghaphery and Associates Inc.
  • Manassas-based Harvey Insurance Agency
  • Virginia Beach-based Mayo Insurance Agency Inc. and Williamsburg Insurance Agency LLC
  • Richmond-based Ronnie Shriner Insurance Agency

All agencies’ principals and teams will join THG’s Mid-Atlantic regional operations.

THG was founded in 2009 and has been a portfolio company of Washington, D.C.-based investment management company The Carlyle Group since 2019. Across its more than 100 offices in 21 states, the company employs more than 900 people. THG has acquired more than 100 companies.

Arlington tech company names health operations lead

Arlington-based technology services provider Halfaker and Associates LLC announced Wednesday that it has named Katrina Tuisamatatele as deputy executive vice president of health operations.

With more than 25 years of experience, Tuisamatatele most recently worked for the Department of Veterans Affairs’ Office of Information & Technology (OI&T), where she served as director of the health portfolio. She led and managed IT planning and execution for more than 140 projects and 350 health care products for veterans.

In her new role, she will oversee all projects within Halfaker’s health division.

“I am pleased to welcome Katrina to the team,” Halfaker President and CEO Dawn Halfaker said in a statement. “Her unique blend of technology, health care and leadership experience will strengthen our health portfolio and enhance our ability to deliver critical healthcare IT services and solutions to all Americans, including our military service members and veterans.”

The company’s health portfolio includes programs for the Department of Veterans Affairs, the Centers for Medicare and Medicaid Services, the Defense Health Agency, the Department of Health and Human Services, and the Food and Drug Administration. Halfaker is a service-disabled, veteran-owned, woman-owned small business that offers mission services for the federal government.

 

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