Report | June 26, 2013

Improvements Needed in the Oversight of the Medical-Support Services and Award-Fee Processes Under the Camp As Sayliyah, Qatar, Base Operations Support Services Contract


What We Did

Our objective was to determine whether DoD officials were properly administering the Camp As Sayliyah, Qatar, Base Operations Support Services (QBOSS) contract, valued at $143.4 million. This report is one in a series and focuses on the administration of the award-fee process and medical services major functional area of the contract.  

What We Found

DoD officials did not administer the medical services major functional area of the QBOSS contract in accordance with the Federal Acquisition Regulation (FAR). Specifically, the contracting officer and the administrative contracting officer allowed contractor physician assistants to provide medical services without proper supervision, and Landstuhl Regional Medical Center (Landstuhl) officials erroneously authorized the Area Support Group–Qatar command surgeon to supervise contractor physician assistants under a non-personal services contract. This occurred because the contracting officer did not clarify the contractor’s responsibility, and Army regulation does not prohibit Government employees from supervising physician assistants providing services under a non-personal health care contract.   

Furthermore, contracting officials did not verify the contractor possessed required authorizing documentation before performing medical services. Specifically, Army officials did not verify a physician assistant’s license was active before granting clinical privileges; contracting officials and Landstuhl officials did not ensure the contractor obtained host-country waivers for medical personnel; and the contracting officer did not verify the contractor indemnified the U.S. Government. This occurred because Landstuhl officials did not have a written standard operating procedure for verifying authorizing documentation. In addition, contracting officials and the contractor did not know the requirements for obtaining host-country waivers. In addition, contracting officials did not properly administer the award-fee process. Specifically, Army officials did not adequately document and justify an award fee of approximately $1.5 million paid to the contractor and the contractor received the award fees even though required critical positions were unfilled.  

This occurred because the award-fee plans used to evaluate the contractor’s performance were not consistent with FAR, and performance monitors were not trained on award-fee evaluation criteria nor on how to provide ratings that represent the intent of an award-fee contract. As a result, contracting officials put the DoD at risk of liability for claims of negligent medical treatments, receiving less-than-optimal health care, and violating host-country laws. Moreover, there was no assurance the contractor was motivated to improve performance in the rated areas, and the Army may not be able to justify continued use of an incentive-type contract with award fees valued at approximately $2.59 million.

What We Recommend

Among other recommendations, we recommend the Commander, U.S. Army Medical Command, revise guidance and the Commander, Landstuhl Regional Medical Center, establish procedures in line with the guidance. We also recommend the Director, Army Contracting Command–Rock Island, require the contractor to provide a medical health services manager who is a medical doctor to supervise the professional aspects of physician assistants’ duties and that the Commander, Defense Contract Management Agency–Kuwait, provide clear instructions and training regarding award-fee plans and evaluations.  

Management Comments and Our Response

Management comments were responsive, and no additional comments are required.