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Title page 1

Contents 4

Highlights 2

Letter 7

Background 10

CBP Processing and Medical Care for Individuals in Custody 12

Medical Services Contracts 16

CBP Roles and Responsibilities for Medical Services Management and Oversight 19

CBP Has Developed Medical Care Policies and Guidance, but Has Not Consistently Implemented Them 21

CBP Developed Policies and Guidance for Providing Medical Care to Individuals in Custody 21

CBP Took Various Steps to Implement Aspects of Its Medical Care Guidance 23

CBP Did Not Consistently Ensure That Individuals in Custody Received Medical Assessments When Required 25

CBP Did Not Consistently Implement Policies and Guidance for Processing and Monitoring Medically High-Risk Individuals 33

CBP Has Limited Oversight into the Medical Care of Individuals at Facilities Without Contracted Medical Personnel 42

CBP Did Not Consistently Provide Required Medical Documentation to Individuals Leaving CBP Custody 44

CBP Did Not Consistently Manage or Oversee Its Medical Services Contracts 45

CBP Had Gaps in Its Management of Its Bridge II Medical Services Contract 46

CBP Has Gaps in Its Oversight of Contractor Performance for Medical Services 55

Conclusions 67

Recommendations for Executive Action 70

Agency Comments and Our Evaluation 72

Appendix I: Objectives, Scope, and Methodology 75

Appendix II: Comments from the Department of Homeland Security 81

Appendix III: GAO Contacts and Staff Acknowledgments 93

Tables 4

Table 1. Obligations for U.S. Customs and Border Protection Medical Services Contracts in Effect, Fiscal Year 2016-August 2025 16

Table 2. Overview of U.S. Customs and Border Protection's (CBP) Key Policies and Guidance on Medical Care for Individuals in Custody... 22

Table 3. Individuals in U.S. Customs and Border Protection (CBP) Custody Who Did Not Receive a Medical Assessment or a Medical... 31

Table 4. Department of Homeland Security (DHS) Contracting Officer's Representatives' (COR) Federal Acquisition Certification Levels 59

Figures 4

Figure 1. U.S. Customs and Border Protection (CBP) Total Encounters Along the Southwest Land Border from Fiscal Years 2021-2024 11

Figure 2. Contracted Medical Personnel Office at a U.S. Customs and Border Protection Facility 14

Figure 3. Processing Steps for Individuals Encountered Between Ports of Entry by Border Patrol and at Ports of Entry by Office of Field Operations (OFO) 15

Figure 4. Timeline of U.S. Customs and Border Protection's (CBP) Medical Services Contracts' Key Procurement Events and Decisions, September 2020-May 2025 18

Figure 5. U.S. Customs and Border Protection (CBP) Offices and Positions with Management or Oversight of Medical Services 20

Figure 6. Medical Supplies at U.S. Customs and Border Protection Facilities 24

Figure 7. U.S. Customs and Border Protection (CBP) Job Aids for June 2023 Medical Process Guidance 25

Figure 8. Individuals in U.S. Customs and Border Protection Custody Waiting for a Medical Assessment 27

Figure 9. Percentage of Individuals in U.S. Customs and Border Protection (CBP) Custody Who Received a Medical Assessment as Required... 29

Figure 10. Time-in-Custody for Individuals Designated Medically High-Risk versus Low-Risk in U.S. Customs and Border Protection (CBP)... 35

Figure 11. A Red Wristband Requirement for Medically High-Risk Individuals in U.S. Customs and Border Protection (CBP) Custody 38

Figure 12. U.S. Customs and Border Protection's (CBP) Contractor Past Performance Evaluations for the Medical Services Contracts as of August 2025 63

Figure 13. U.S. Customs and Border Protection's (CBP) Five Elements for Ensuring the Medical Services Contractor's Performance... 65

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