Audit Objectives

The objectives of the audit were to determine whether management controls established by the USMS will reasonably assure that: 1) prisoners are provided necessary health care, 2) prisoners are screened for communicable diseases, 3) costs are necessary and reasonable, and 4) prisoners are provided secure transport to off-site facilities to receive medical treatment.

Scope and Methodology

The scope of the audit encompassed USMS management of prisoner medical care from FY 2000 through FY 2003 and was conducted in accordance with generally accepted government auditing standards. Our primary focus was on management activities at the district office. We conducted fieldwork at 16 USMS district offices and performed statistical sampling of internal controls over prisoner medical care at 14 of those district offices.

To complete the audit, we: 1) researched and reviewed applicable laws, policies, regulations, manuals, and memoranda; 2) interviewed officials at the USMS and BOP; 3) conducted fieldwork at 16 district offices located in Los Angeles, CA; San Diego, CA; San Francisco, CA; Sacramento CA; Philadelphia, PA; Brooklyn, NY; Buffalo, NY; Tampa, FL; Topeka, KS; Phoenix, AZ; Albuquerque, NM; Chicago, IL; Washington, DC; Columbia, SC; Houston, TX; and San Antonio, TX, as well as USMS Headquarters in Washington, DC; 4) selected and reviewed a statistical sample of 900 vouchers from a universe of 6,525 obtained from the USMS FMS system. In conducting our audit, we relied on computer-processed data. We tested the accuracy of the data by tracing it to original source documents.

For objective 1, we interviewed USMS officials, reviewed USMS policy and procedures, prisoner files, and documents related to: 1) prisoner deaths, 2) litigation resulting from prisoner medical issues, 3) evaluations and audits of health care services provided by contract jail facilities, and 4) internal controls associated with the USMS cellblock health screening.

For objective 2, we obtained and reviewed USMS policies and procedures related to internal controls established to mitigate the risk of spreading such infectious diseases as TB, HIV/AIDS and hepatitis.

We interviewed a judgmental sample of deputy marshals to determine if they understood the outward signs of TB and knew what action to take if they encountered a prisoner displaying symptoms of the disease.

In addition, we reviewed records of prisoners in USMS custody from October 1, 2001, through September 30, 2002, who were diagnosed with active TB. We determined if the case was reported to the Office of Interagency Medical Services (OIMS). We verified if the prisoner was immediately taken to a medical facility for treatment and remained in a medical facility until the diagnosis was confirmed and treatment completed.

To determine whether USMS personnel adequately screened prisoners for communicable diseases, such as TB, hepatitis, and HIV/AIDS, we interviewed officials at USMS Prisoner Services Division (PSD), the OIMS, select USMS districts, and local jails. We also examined USMS district prisoner files for evidence of documentation of TB screening, testing and status. We reviewed printouts from the Prisoner Tracking System (PTS) for information on TB test date and results, and current or past TB diagnosis and treatment. Further, we analyzed BOP and jail communiqués regarding medical clearance of prisoners.

For objective 3, we selected a statistical sample of outside medical payment transactions for review from FY 2002 vouchers listed on the USMS's Financial Management System to determine whether: 1) the prisoner was eligible for treatment, 2) the procedure was properly authorized, 3) the medical procedure was necessary, and 4) the payment was accurately recorded and supported by documentation.

We interviewed district officials in order to assess the internal controls that have been established to mitigate the risk of fraud, or the excessive cost resulting from: 1) treatment of ineligible prisoners, 2) unnecessary medical treatment, 3) duplicate or over-priced medical bills, 4) payment of costs covered by the prisoner's private medical insurance, and 5) procurement of non-generic drugs.

We interviewed district officials and reviewed randomly selected medical bills to establish if outside medical services were being procured in accordance with federal regulations.

To complete objective 4, we randomly selected hospital guard payment transactions for review from FY 2002 vouchers listed on the USMS's Financial Management System and determined if the payments were properly authorized, accurate, and fully supported by documentation.

We judgmentally selected and reviewed the personnel files for contract hospital guards. By reviewing these files we found if the hospital guards utilized by the USMS met the qualification standards for job experience, background, physical fitness, and training.

We interviewed the COTR of the district's hospital guard contract in order to determine if the COTR was qualified for their position and to determine if they were fully performing the COTR duties.