HomeMy WebLinkAboutR-04-0171City of Miami
Legislation
Resolution: R-04-0171
City Hall
3500 Pan American
Drive
Miami, FL 33133
www.miamigov.com
File Number: 04-00200 Final Action Date: 3/11/2004
A RESOLUTION OF THE MIAMI CITY COMMISSION WITH
ATTACHMENT(S), ACCEPTING THE RECOMMENDATION OF THE CITY
MANAGER APPROVING THE FINDINGS OF THE EVALUATION COMMITTEE,
PURSUANT TO REQUEST FOR LETTERS OF INTEREST ("RFLI") NO.
02-03-241, THAT THE TOP -RANKED FIRM TO PROVIDE A COMPREHENSIVE
RETROSPECTIVE CLAIMS AUDIT, HOSPITAL BILL AUDIT, DRG VALIDATION,
FRAUD AND ABUSE DETECTION, COORDINATION OF BENEFITS, AND THIRD
PARTY LIABILITY REVIEWS FOR THE CITY OF MIAMI'S MEDICAL PLAN
CURRENTLY ADMINISTERED THROUGH CIGNA, FOR THE DEPARTMENT OF
RISK MANAGEMENT, IS HEALTHCARE DATA MANAGEMENT, INC. ("HCDM");
AUTHORIZING THE CITY MANAGER TO NEGOTIATE A PROFESSIONAL
SERVICES AGREEMENT, IN SUBSTANTIALLY THE ATTACHED FORM, AT A
ONE-TIME FEE, IN AN AMOUNT NOT TO EXCEED $20,000, FULLY
REFUNDABLE, CONTINGENT UPON SAVINGS RENDERED UPON
COMPLETION OF THE CURRENT HEALTH CARE PROVIDER (CIGNA) AUDIT,
PLUS THE RECEIPT OF 35% OF TOTAL RECOVERED FUNDS; ALLOCATING
FUNDS FROM ACCOUNT CODE NO. 514401.623301.6.657; DIRECTING THE
CITY MANAGER TO PRESENT THE NEGOTIATED AGREEMENT TO THE CITY
COMMISSION FOR CONSIDERATION.
WHEREAS, Request For Letters of Interest ("RFLI") No. 02-03-241 was issued to secure a
Health Care Claims Audit Provider to perform a comprehensive retrospective claims audit, hospital
bill audit, DRG Validation, fraud and abuse detection, coordination of benefits, and third party
liability reviews for the City of Miami's ("City") medical plan currently administered through Cigna;
and
WHEREAS, two (2) proposals were received, deemed responsive and responsible, and
evaluated by the Evaluation Committee; and
WHEREAS, following evaluation, the Evaluation Committee recommended that the City
negotiate a Professional Services Agreement, in substantially the attached form, with the
top -ranked firm, Healthcare Data Management, Inc. ("HCDM"); and
WHEREAS, funds in an amount not to exceed $20,000, to be refunded in full upon savings as
a result of the Cigna audit, will be provided from Account Code 514401.623301.6.657, along with
the receipt by HCDM of 35% of the total recovered dollars in the form of refunds, credits,
adjustments and/or settlements as a result of their work;
NOW, THEREFORE, BE IT RESOLVED BY THE COMMISSION OF THE CITY OF MIAMI,
FLORIDA:
City of Miami
Page 1 of 2 File Id: 04-00200 (Version: 11 Printed On: 9/1/2016
File Number: 04-00200 Enactment Number: R-04-0171
Section 1. The recitals and findings contained in the Preamble to this Resolution are adopted
by reference and incorporated as if fully set forth in this Section.
Section 2. The City Manager's recommendation approving the findings of the Evaluation
Committee's that the top -ranked firm, to perform a comprehensive retrospective claims audit,
hospital bill audit, DRG Validation, fraud and abuse detection, coordination of benefits, and third
party liability reviews for the City's medical plan currently administered through Cigna is HCDM,
Inc., is accepted.
Section 3. The City Manager is authorized{1} to negotiate an Agreement, in substantially the
attached form, with HCDM, Inc., at a one time fee, in an amount not to exceed $20,000, fully
refundable contingent upon savings as a result of the Cigna audit, plus receipt of 35% of the total
recovered dollars in the form of refunds, credits, adjustments and/or settlements as a result of their
work, with said funds allocated from Account Code No. 514401.623301.6.657.
Section 4. The City Manager is directed to present the negotiated Agreement to the City
Commission for consideration.
Section 5. This Resolution shall become effective immediately upon its adoption and signature
of the Mayor.{1}
Footnotes:
{1} If the Mayor does not sign this Resolution, it shall become effective at the end of ten calendar
days from the date it was passed and adopted. If the Mayor vetoes this Resolution, it shall
become effective immediately upon override of the veto by the City Commission.
City of Miami Page 2 of 2 File Id: 04-00200 (Version: 1) Printed On: 9/1/2016