Inmates’ hospital bills sit in limbo

Auditor says mix-up occurred when sheriff’s department changed payment processes.
Sunday, October 26, 2003 | 12:00 a.m. CDT; updated 4:11 p.m. CDT, Sunday, July 13, 2008

Boone County officials are trying to figure out what to do with $50,000 in unpaid bills submitted by local hospitals for the care of jail inmates.

Just $10,000 had been appropriated for inmate hospital costs for the entire year, Boone County Auditor June Pitchford said. But, after just a few months, Pitchford had paid out nearly three times that amount before realizing something was amiss.

“In the meantime,” Pitchford said, “nothing is being paid. Everything is pending.”

Changing payment system

Inmates must typically pay for their own health care. However, a state law allows local governments to cover an inmate’s health care costs if the sickness or injury occurred after incarceration.

In the past, the Boone County Sheriff’s Department, which administers the jail, sent Pitchford’s office only those hospital bills that should be paid. Hospitalization of inmates has cost Boone County anywhere from $6,000 to $20,000 annually, Pitchford said

But at the start of 2003, the sheriff’s department decided that the law gave county commissioners the responsibility for determining which bills to pay, said Maj. Warren Brewer, jail detention director. The department decided to review the statute, Brewer said, because the jail was spending a lot of time dealing with hospital bill collectors when inmates did not pay their bills.

“Do we need to spend time talking to bill collectors when it’s not even our job?” he said. “We didn’t think so.”

Not what they expected

Pitchford, however, said her office was never notified that, starting this year, the sheriff’s department would begin forwarding all bills, not just those that needed to be paid.

“That change was not communicated to the commission or to myself,” she said. “The invoices submitted to my office were processed in the usual manner and paid.”

Boone County Presiding Commissioner Keith Schnarre said that many of the bills in Pitchford’s office probably would not have been paid when the sheriff’s department was making the decision on which costs the county should cover. Schnarre has been meeting with MU Health Care and Boone Hospital Center, which together treat most of the inmates who need hospitalization, but wouldn’t speculate on when a new policy would be in place.

“I had hoped to get it done by the first of the year,” Schnarre said, “but I really couldn’t say when we will be done.”

Passing the buck

Maurice Manring, a spokesperson for MU Health Care, said it is unreasonable for the county to expect hospitals to care for inmates without being paid for the services.

“Nobody can run a business on a model where you don’t get paid,” he said. “We would like for responsible institutions, such as the criminal justice system, to compensate us when it’s appropriate.”

However, Manring said, hospital officials are optimistic that a solution to the current impasse will be found.

When the county decides to pick up an inmate’s hospital costs it must pay the maximum charge for service. Many inmates are without health insurance, and those who are eligible for Medicaid or Medicare lose those benefits once they go to jail, Brewer said.

A negotiated payment rate and a new billing process are some of the options the county has been exploring, Pitchford said. Such changes would minimize the costs that hospitals are forced to write off due to nonpayment, as well as reduce the costs to Boone County taxpayers.

Pitchford said the billing mix-up has served as a wake-up call to the county.

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