Procedural Reform Recommendation for the Federal Bureau of Prisons

Move immediately to require all CMS contractors to submit electronic claims.

Ensure those claims are properly analyzed and maintained by BOP's adjudication vendor.

Enforce existing contract language that requires the adjudication vendor to perform fraud analytics and report any indicators of fraud to the BOP.

Ensure that the adjudication vendor is able to reproduce on demand all necessary data elements used to adjudicate the claims (e.g., DRG, all procedure codes, and drug information). The universe of claims data should be available to BOP on a national scale in a format that allows for thorough analysis and oversight regardless of institution.