Audit of the U.S. Marshals Service’s Prisoner Medical Request and Medical Claim Review Processes through its National Managed Care Contract with Heritage Health Solutions, Inc.

Remedy the remaining $37,416 of the $43,311 in unsupported medical claims for which the USMS requested recoupment from the medical service providers.

Develop internal control procedures that help ensure that all prisoner medical requests are entered into Capture and help prevent district office personnel from approving medical claims for payment without proper POD-OMO review and approval support in Capture.

Remedy the $33,830 in unallowable medical services identified by the OIG.

Assess the risk associated with the remaining historical costs under this contract to determine if additional recoupment efforts are appropriate and cost beneficial.

Enhance its prisoner medical request and medical claim review training. Specifically, the USMS should : (1) ensure all remaining district office personnel responsible for processing prisoner medical requests and medical claim reviews receive formal training from POD-OMO; (2) revise its procedures to ensure newly assigned prisoner medical request and medical claim review personnel also receive the same training prior to assuming these responsibilities; and (3) provide appropriate medical billing training to help district office personnel more easily match medical services to preauthorization's and identify medical claim deficiencies.

Perform an assessment of its prisoner medical request and medical claim review processes and implement a formal strategy that seeks to centralize critical functions where appropriate and considers modernizing elements of these processes to ensure the most effective and efficient administration of this critical program, including electronic processing. Such processing would enable the USMS to employ data analytical tools in its reviews of medical claims, thereby enhancing its controls and identification of problem areas.

Develop a strategy for obtaining and paying for dental care to maximize cost effectiveness. As part of this effort, the USMS should explore cost saving opportunities, including negotiating dental pricing in its contract solicitation or negotiating prices of common dental procedures with dental providers in order to reduce the variance in prices charged to the USMS.