REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
August 19, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
TRICARE Capital and Direct Medical Education Reimbursement Review Agreement with Healthcare Reimbursement Solutions, LLC
End
RECOMMENDATION(S)
Recommendation
Approve TRICARE Capital and Direct Medical Education Reimbursement Review Agreement with Healthcare Reimbursement Solutions, LLC to review TRICARE Capital and Direct Medical Education reimbursement payments received or receivable for fiscal years 2029 and prior and prepare documentation necessary to correct and collect additional reimbursements from TRICARE, on a contingency fee basis of 18%, effective for five years from the date the agreement is fully executed.
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). Healthcare Reimbursement Solutions, LLC (HRS) will be paid on a contingency fee basis of 18% of any increased reimbursement generated by HRS’ work for fiscal years 2029 and prior. Adequate appropriation and revenue have been included in Arrowhead Regional Medical Center (ARMC) 2025-26 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
HRS will review all TRICARE Capital and Direct Medical Education reimbursement payments received or receivable (including related issues dealing with stale dated, void, or otherwise unclaimed checks) to ARMC for fiscal years ending 2029 and prior. HRS will prepare all documentation necessary to correct and collect the reimbursement from TRICARE for approval and signature by an ARMC representative.
HRS has developed proprietary databases including data from Medicare’s Healthcare Cost Report Information System (HCRIS), TRICARE - Department of Defense, 3rd Party Hospital and Health System demographics data, creating a detailed picture of reimbursement recovery opportunities. HRS reimbursement experts identify reimbursement opportunities that are often overlooked, and hospital staff rarely have the time or resources to recover all of what is owed. HRS’ research and analysis provide valuable insight by identifying the specific hospitals and fiscal years where opportunity resides. HRS staff and principals have been assisting hospitals since 1996 and have directly been responsible for more than $500,000,000 of additional recovery paid to hospital providers. ARMC previously contracted with HRS to provide these services from March 26, 2021 to March 25, 2022.
HRS’ compensation will be based solely on any increased reimbursement generated by HRS’ work. Increased reimbursement shall be defined as any payments or credits and newly issued checks based on stale dated checks issued to or received by ARMC identified by HRS for fiscal years 2029 and prior. HRS’ compensation will not be reduced by the identification of overpayments made to ARMC in prior years. ARMC will compensate HRS pursuant to the following schedule: ARMC will pay HRS 18% of all increased reimbursement generated, as defined above, by HRS. HRS will invoice ARMC once ARMC receives payment. ARMC agrees to pay the above invoices within 60 days from the date of receipt.
ARMC recommends approval of the Agreement with HRS, to operate in a fiscally-responsible manner by the review of TRICARE Capital and Direct Medical Education reimbursement payments received or receivable to ARMC and the preparation of documentation necessary to correct and collect additional reimbursements from TRICARE.
PROCUREMENT
The Purchasing Department supports this non-competitive procurement based on the specialized credentials and expertise of HRS. HRS has the most comprehensive database of TRICARE capital and Direct Medical Education payments made to hospital providers. The data is comprehensively modeled against the hospital HCRIS data in HRS’s proprietary databases to identify reimbursement impacts.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5455) on June 20, 2025; Purchasing (Veronica Pedace, Buyer III, 387-2464) on June 24, 2025; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on July 28, 2025; and County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on July 31, 2025.