(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...

Respondents must base their Cost Proposals on the Scope of Work described in the RFP and
must complete, sign, and date the Cost Proposal verifying that the enclosed information is valid
for 180 days from date of submission. The signature must be that of an authorized
representative of the respondent.
The Cost Proposal should include any business, economic, legal, programmatic, or practical
assumptions that underlie the Cost Proposal. HHSC reserves the right to accept or reject any
assumptions. All assumptions not expressly identified and incorporated into the applicable
Contract resulting from this RFP are deemed rejected by HHSC.
A cover letter referencing the Cost Proposal, Proposed Compensation Tables and Proposed
Fixed Fee Rates Schedule must be included in the respondent’s separate, sealed package, and
must be signed by an individual authorized to legally bind the respondent for the Cost Proposal,
Proposed Compensation Tables and Proposed Fixed Fee Rates Schedule submitted.
The RAC’s compensation for overpayments will be based on the actual amount recovered by
HHSC from the improper payment recovery review process and the RAC will be paid a
contingency fee percentage of the amount recovered. The amount will be considered recovered
only after HHSC receives the payments from its providers. The RAC will not be paid by HHSC
unless HHSC secures payment from the applicable provider and any appeals are resolved. Any
payments made to the RAC that are later refunded by HHSC to the provider as a result of an
overturned appeal will be refunded to HHSC within a reasonable timeframe as prescribed by
HHSC or offset against future payments to the RAC. .
The RAC’s compensation for underpayments will be based on the amount of the actual
underpayment amounts paid to providers identified from the improper payment recovery review
process and the RAC will be paid either a contingency fee percentage of the underpayments
actually paid to providers or a fixed fee.
The RAC’s compensation for other audit services related to fraud investigations will be based on
Fixed Fees mutually agreed upon by HHSC and the RAC. The Fixed Fees will be based on
individual Fixed Fee Rates included in the Contract and the level of effort to perform a specific
audit, audit services related to fraud investigations or any other service provided by the RAC
that would not be appropriate to utilize a contingency fee to compensate the RAC for those
specific services rendered. The respondent should include the proposed individual Fixed Fee
Rates that would be utilized during the initial 12 month operational period. The respondent
should also provide examples of fixed fee rates received for fraud-related audit services
performed under other similar contracts.
Respondents are to complete the Proposed Compensation Tables and Proposed Fixed Fee
Rates Schedule, Attachment A, according to these instructions. The contingency percentage
rate(s) and/or fixed fee rate offered in the Respondent’s Cost Proposal will be the compensatory
percentage rate(s) based only on overpayment amounts collected and underpayments identified
and paid to the providers pursuant to the RFP throughout the contract period as described in
this RFP. Respondents are to use the format(s) in Attachment A to submit their firm, fixed, allinclusive
compensatory percentage rate(s) that covers all SFYs (i.e, 13, 14, 15 16 17 and 18)
and the Fixed Fee Rates for the initial operational period (SFY 2013). At the Respondent’s
discretion, additional documentation may also be included with the completed Attachment A as
explanatory information, but when making the RAC selections and when executing the contract,
HHSC will consider only the proposed percentage rate(s) and the proposed fixed fee rates
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