Nassau Comptroller's Office Issues Report
on Costs for Inmate Care Provided by NUMC

Mineola - Nassau County's auditors have reported on the costs of the care provided by Nassau Health Care Corporation, the public benefit corporation that runs the struggling Nassau University Medical Center (NUMC) in East Meadow, to inmates at the county's correctional center.

An examination of health care costs associated with medical services for inmates at the Nassau County Correctional Center, conducted by the office of Nassau County Comptroller Howard S. Weitzman, notes that Nassau County is paying considerably more than Suffolk and Westchester counties for such health care costs and that NUMC has no financial incentives to monitor, contain or reduce costs since its income rises with them.

Although it spent $14.9 million in 2000 on medical services for inmates at the Nassau County Correctional Center -- in contrast to some $5 million in neighboring Suffolk County -- the quality of care provided by Nassau Health Care Corporation has come under scrutiny by the United States Justice Department as part of its investigation of conditions of confinement at the correctional center.

"Our own review was limited in scope to the financial aspects of the county's arrangements with the medical center to provide care for inmates," said Weitzman. He noted that members of his audit staff met with representatives of both the medical and correctional centers and contacted other municipalities to compare health care costs. Based on that review, Weitzman maintains: "The long-term contract with Nassau Health Care Corporation should be revisited and its terms re-examined to ensure that cost-effective care is provided."

The comptroller's audit report includes the following findings:

• The correctional center's per-capita medical care costs in 2000, based on its average daily census, amounted to $10,207, in contrast to $3,476 in Suffolk.
  
• In 2002, correctional center medical care costs are projected to be more than 283 percent higher than Suffolk County's, although Nassau's inmate census exceeds Suffolk's by only 14 percent.
  
• While Westchester County claims to have realized savings through competitive bidding for providers and cost monitoring, Nassau's cost-plus contract does not provide financial incentives for monitoring, containing or reducing costs.
  
• NUMC has not provided necessary operational and management cost-control reports to the Nassau County Correctional Center.
  
• The total infirmary personnel costs for NUMC in 2000 were $4.2 million (excluding a 21-percent administrative fee), while Suffolk County's costs were $2.6 million.
  
• The correctional center lacks a qualified professional to monitor NUMC charges and has not put in place formal cost-control procedures or review functions to ensure that charges are correct and justifiable.
  
• The agreement between the county and the corporation does not set forth operational requirements -- including staffing and reporting arrangements -- for the provision of appropriate medical care.
  
• Although NUMC states it makes efforts to recover inmate medical costs from third-party insurance carriers, it does not provide the correctional center with periodic summaries containing the amounts and details of these recoveries.
  
• A lack of effective oversight by NUMC appeared to add to the escalating cost of drugs, which rose 39 percent during the first eight months of 2001 without a corresponding increase in the inmate population.
  
• Beyond verifying whether a charge was for an individual incarcerated at the correctional center at the time the charge was incurred (audits have previously disclosed charges for individuals who were not inmates at the time of service), the correctional center lacks the ability to verify that billed services were actually performed, that charges were at the contractual rate, and that medical procedures performed were necessary.
  
• Infirmary and mental health department billings may be duplicative.
  
• While NUMC is concerned about the charges it must pay to its energy provider, the utility bills for electricity and for steamed and chilled water from the medical center to the correctional center do not reflect actual costs.

"At a time when we're painstakingly seeking to return Nassau County to fiscal health and prevent further hemorrhaging, it behooves the leadership of NUMC and the correctional center to jointly study inmate health practice and procedures and develop a workable plan whose primary objective should be to provide quality care at a reasonable cost in compliance with applicable laws, regulations and court orders," said Weitzman.

He noted that in response to the draft audit issued by his office, both NUMC and correctional center representatives have told him they will be retaining outside experts to further examine the financial aspects of correctional health. "I hope that as a result of the work of my auditors and the outside experts, changes will be made to ensure cost effective, appropriate health care delivery," said Weitzman.

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NASSAU HEALTH CARE CORPORATION NASSAU COUNTY CORRECTIONAL CENTER LIMITED EXAMINATION OF HEALTH CARE COSTS & OTHER MATTERS 1999-2001 (~54.8kB - 21 pages.pdf )