Local Politics

Audit: Medicaid billing could cut state inmate health costs

Posted August 24, 2010

— The state Department of Correction could cut the health costs for inmates by $11.5 million a year by requiring hospitals and other medical service providers to bill Medicaid for eligible expenses, according to a state audit released Tuesday.

The amount of potential savings would increase in 2014, when health care reform expands Medicaid eligibility, auditors said.

A previous audit found that the DOC has allowed hospitals and other medical providers to dictate the terms of contracts for inmate medical care, leading to a range of pricing. In some instances, hospitals charged the state rates called for under the contracts when the actual cost of care was far lower.

On average, providers billed the DOC at rates 467 percent of reimbursement rates under Medicare or Medicaid, according to the previous audit. For example, the department paid WakeMed $482,000 for a trauma case that Medicare would have paid $120,000 to treat.

During the 2008 and 2009 calendar years, the DOC paid about $159.8 million for inmate health care, auditors said in the new audit.

Generally, the federal government doesn't reimburse states for inmate medical care, but auditors confirmed with federal regulators that Medicaid would cover the for inmates treated in private or county-run hospitals who meet Medicaid eligibility requirements.

Billing Medicaid would not only reduce the charges that DOC is paying for inmate care, the auditors said, it also would provide the state with a reimbursement from the government of 65 cents for every $1 spent, according to the audit.

DOC Secretary Alvin Keller said the department is working with the state Department of Health and Human Services to identify which inmates meet Medicaid requirements, and they hope to begin next month reviewing all hospital admissions of inmates for possible Medicaid reimbursement.

Keller said he doubts the state could save as much as auditors predict because a provision in the 2010-11 state budget allows the DOC to reimburse medical providers no more than 70 percent of billed charges. He said he also expects future contracts for inmate health care to include more favorable terms for the state.

Auditors said North Carolina counties also could use Medicaid billing to cut the cost of treating inmates in their jails.

23 Comments

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  • sniperdiver Aug 24, 7:56 p.m.

    Inmates should have to truely pay for their own medical expenses. No money, no medical. They get better care than Blue Cross / Blue Shield Offers state employees. Prison life is easy. Maybe NC can learn from how from South American Prisons about medical care for inmates. I bet recidivism would drop.

  • kimvian Aug 24, 7:27 p.m.

    OMG!!! how do inmates get such special treatment??? all of them will qualify for our pathetic medicaid system. how about NO health care at all? they should not have broke the law. let them get sick and die off, that will be cheaper than anything!!

  • kbo80 Aug 24, 7:22 p.m.

    If inmates really wanted health care then they would work and pay for it like most of us up here. I know I pay my share.

  • iamsiam1096 Aug 24, 6:35 p.m.

    the article states "the department paid WakeMed $482,000 for a trauma case that Medicare would have paid $120,000 to treat." since when had medicare ever paid the true COST of something. Why do you think Doctors are running from Medicare? Using medicare as the "true cost" is inane.

  • Sherlock Aug 24, 5:37 p.m.

    Great, make them pay the bills are do without like alots of us. Did not Obama say everyone had to buy health insurance... Why not go back and check all inmates and take the Social Security funds and pay the bills.

  • Just the facts mam Aug 24, 4:27 p.m.

    How about this - if inmates want health care, pay for it like the rest of us have to - why are violent criminals getting free health care, while the rest of us have to pay for our health care (and theirs too!!!)

  • LuvLivingInCary Aug 24, 4:24 p.m.

    guys this is nothing more than a pr article to make bev purdue look great.

    the state has looked at this for many many years and never done anything about it. if they magically think the feds are going to magically step up and fund 65% of this you are fooling yourself. they feds will lower the reimbursement rate to compensate and then everyone gets less. you know now it's spread around.

    remember that the people they will be taking money from are the hospitals and they are a powerful entity...look up the nc hospital association.

    it's all smoke and mirrors. i don't buy it at all and i knowvalue..

  • JustOneGodLessThanU Aug 24, 3:56 p.m.

    LoveSomeGolo, go get 'em! :-)

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    U.S. Department of Health and Human Services 1-800-447-8477.

    Or email: hhstips@oig.hhs.gov

    Provide a brief description of the Food Stamp fraud. Ensure that you include specific instances where you have witnessed the abuse.

    You can remain anonymous.

  • colliedave Aug 24, 3:55 p.m.

    One thing not mentioned in the article is there are large hospitals under construction at both NCCIW and Central Prison.

  • wildcat Aug 24, 3:46 p.m.

    Then they would still have to deal with the sick inmate, wouldn't they. It would be inhuman not to take care of them.

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