Department of Justice (DOJ) Acting Inspector General William M. Blier announced today the release of a report on the U.S. Marshals Service (USMS) prisoner medical request (PMR) and medical claim review (MCR) processes and the USMS’s administration of the National Managed Care Contract (NMCC) awarded to Heritage Health Solutions, Inc. (Heritage). The USMS is responsible for providing necessary medical care for an individual throughout the duration of USMS custody. To facilitate the delivery of health care to USMS prisoners, the USMS awarded the NMCC to Heritage in 2017 with expenditures of approximately $660 million through FY 2024.
The DOJ Office of the Inspector General (OIG) found that the USMS should improve the management and oversight of its prisoner medical request and medical claim review processes to better ensure the approximately $60 million spent annually on medical services for over 50,000 prisoners in custody are expended for medically necessary and properly authorized services. During the 15-month period covered by our review, we tested nearly 500 medical claims from 17 USMS district offices, totaling almost $3.8 million, and identified significant inefficiencies in the decentralized manual approach used for processing over 9,000 claims monthly.
The OIG’s findings included the following:
- USMS Should Improve PMR and MCR Processes. In our review, we found 38 unsupported medical claims totaling $43,311 that did not receive the required approval prior to payment; and 51 medical claims totaling $33,830 where the USMS paid for unallowable services. We determined these discrepancies resulted from communication gaps associated with USMS policy revisions, as well as non-compliance likely as a result of inadequately trained USMS district office personnel who often perform the PMR and MCR processes as a secondary duty.
- Improvement Opportunities for Dental Claims. We found that USMS missed opportunities to control costs when providing dental services. USMS did not request rates for dental services in its solicitation for the NMCC, which resulted in USMS paying varying amounts to different providers for the same dental services. We also identified discrepancies demonstrating that the access to care to USMS prisoners for dental services may not be consistent across the 95 USMS districts. USMS should evaluate and ensure access to dental care provided to USMS prisoners throughout the 95 USMS districts is aligned with applicable community standards for access to health care services.
The DOJ OIG made 13 recommendations to improve USMS management of the PMR and MCR processes and the NMCC contract with Heritage. USMS agreed with all recommendations.