The Federal Bureau of Prison's Efforts to Manage Inmate Health Care

Audit Report 08-08
February 2008
Office of the Inspector General

Appendix I
Audit Objectives, Scope, and Methodology


The objectives of this audit were to determine whether the BOP: (1) appropriately contained health care costs in the provision of necessary medical, dental, and mental health care services; (2) effectively administered its medical services contracts; and (3) effectively monitored its medical services providers.

Scope and Methodology

We performed the audit in accordance with Government Auditing Standards and included tests and procedures necessary to accomplish the objectives. We performed the audit from January 16, 2007, to November 14, 2007. We conducted fieldwork at the following locations:

BOP Headquarters Washington, D.C.
USP Atlanta Atlanta, Georgia
FMC Carswell Forth Worth, Texas
USP Lee Jonesville, Virginia
FCC Terre Haute Terre Haute, Indiana
FCC Victorville Victorville, California

Health Care Costs

To determine whether the BOP appropriately contained health care costs we:

Medical Care Services Provided

We initially determined that the BOP’s Preventive Health Care Clinical Practice Guideline included the appropriate provisions to use in testing the BOP’s overall inmate health care. We selected this guideline as the basis for our testing because it:

From the medical procedures listed in the guideline, we developed a list of 30 medical procedures to test. We selected a preliminary statistical sample of 251 inmates at USP Atlanta, because our sample was representative of the inmates incarcerated there. We reviewed the medical records of the inmates in our sample and determined if they received the applicable service required based on age or medical need. To validate our testing, we asked a USP Atlanta Health Service Unit official to verify the results of our review to ensure that we had not overlooked any reference to the provision of any medical service tested. Our preliminary test results showed that inmates did not receive all the necessary health care services, and we expanded our testing to include other BOP institutions.

For our expanded audit testing, we selected 859 additional inmates at 4 additional BOP locations within 4 of the BOP’s regions. Including the preliminary sample reviewed at USP Atlanta, our sample consisted of 1,110 inmates at 5 BOP locations in 5 BOP regions. Appendix IV explains our sampling methodology. The sample size we tested at each location is shown in the following table.

Location of Institutions Sample
USP Atlanta 251
USP Lee 133
FCC Terre Haute 249
FMC Carswell 127
FCC Victorville 350
Total 1,110
Source: OIG sample from BOP inmate population data

Medical Services Contractor Oversight

To determine whether the BOP effectively administered its medical services contracts we:

To determine whether the BOP effectively monitored its medical services providers we:

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