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:
obtained and analyzed health care cost data from FYs 2000 to 2007 to identify long-term trends in costs;
identified the major BOP cost containment initiatives since FY 2000;
reviewed each BOP initiative to identify the original implementation plan, budget, and anticipated impact on costs and then assessed the implementation of each initiative; and
evaluated the cumulative effect of the initiatives on health care costs.
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:
addressed care for all inmates, instead of just inmates with specific illnesses;
included the diagnostic procedures for all but 2 of the chronic conditions addressed in the other 15 guidelines;
contained definitive and finite medical services that could be tested for completion, while testing of services in the other 15 guidelines would require medical expertise; and
is a primary objective of the BOP in its efforts to contain costs and promote health and prevent disease.
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
|FCC Terre Haute||249|
Medical Services Contractor Oversight
To determine whether the BOP effectively administered its medical services contracts we:
reviewed previous OIG audits of comprehensive BOP medical services contracts and identified similar conditions and causes of contract administration deficiencies existing at multiple BOP institutions;
interviewed personnel at five BOP institutions and determined if the causes for the deficiencies also existed at those BOP facilities;
used a questionnaire to survey all other BOP institutions to determine if the causes for the deficiencies also existed at those institutions; and
determined whether the BOP developed and issued policies and procedures to address any systemic deficiencies.
To determine whether the BOP effectively monitored its medical services providers we:
evaluated the BOP’s review process for monitoring contractor performance at the national, regional, and institutional levels;
determined whether the five BOP institutions selected for testing had implemented adequate monitoring processes of their health care providers;
surveyed BOP institutions through a questionnaire to determine if they had implemented adequate monitoring processes for health care providers;
assessed whether the BOP’s monitoring system for health care is capable of detecting the types of deficiencies identified in this and prior OIG audits; and
determined whether the BOP performed trend analyses of its program review findings to identify systemic deficiencies and issued BOP-wide guidance to address the weaknesses.