This final report points out that standard medical care is provided at no charge to research patients at the National Institutes of Health (NIH) Clinical Center for treatment for medical conditions unrelated to research. Moreover, standard medical care was provided to some patients who were not even participating in research. We believe such care should be billable to insurers and other third party payers. We recommended that: (1) NIH modify its accounting and information systems to collect the full cost of treating patients, (2) segregate research costs from nonresearch care costs by patient, (3) collect insurance and financial information from patients, and (4) seek authority to charge for nonresearch care provided to patients. The Public Health Service (PHS) forwarded our report to a workgroup established to review activities of the Department, including operations of the Clinical Center, under REGO II (the second phase of the National Performance Review's efforts to reinvent Government). The PHS will revisit our recommendations in conjunction with those of the workgroup to determine an appropriate course of action.