The U.S. Government Accountability Office said it found that Aetna created
the appearance of an unfair advantage in its pursuit of the Tricare
contract it was awarded earlier this year. The GAO is recommending that the
government re-evaluate the contract bids.
Tricare is the Dept. of Defense's health plan for current and retired
military service members, their families and survivors. Tricare management
is split into three regions: South, North and West.
The new North contract, originally awarded to Aetna, would be worth an
estimated $16.7 billion over five years.
The GAO upheld a contract award protest by Health Net, which holds the
current Tricare contract for the North region. The partially redacted
decision and recommendations were released to the public Nov. 17.
Among several reasons it listed to uphold Health Net's protest, the GAO
found that Aetna "created the appearance of impropriety" in its pursuit of
the contract by hiring a former chief of staff for the Tricare Management
Activity to prepare its bid.
Though it did not examine whether an unfair advantage actually existed, the
GAO did find that Aetna created what could be perceived as one. The former
TMA official Aetna hired had access to inside information, and Aetna should
have disclosed that to the bid review officer, the GAO found.
Aetna spokesman Alfred Laberge said in an e-mailed statement, "We look
forward to TMA's review of these issues and feel confident that Aetna acted
appropriately at all times." He did not specifically address any of the
GAO's findings.
Health Net spokeswoman Molly Tuttle said the company was "pleased with the
outcome and strong findings in our sustained protest," and would await the
TMA's decision whether to accept the GAO's recommendations. The TMA has
until Jan. 4, 2010, to make that decision.
The GAO also has recommended that Tricare re-bid the contract for the South
region, sustaining a protest by incumbent contractor Humana, which had lost
out to UnitedHealth Group in the bid process for the next contract
period.
TriWest Healthcare Alliance, the current contractor for the West region,
won the contract for the next five years.
The full and original article can be found here:
http://www.ama-assn.org/amednews/2009/11/30/bisf1203.htm
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