The Nassau Health Care Corp., which runs the county's only public hospital, wrote off nearly $8 million in patient charges in 2011 and 2012 because of faulty billing procedures, according to an audit released Tuesday by Nassau Comptroller George Maragos.

The report, a follow-up to an audit released by Maragos in March 2011, found NHCC also failed to fix questionable procurement practices that led to millions of dollars in contract costs without competitive bidding.

"Hospital management continues to operate with impunity," said Maragos, a Republican. "We identified these problems two years ago but there has been no improvement or effort to fix these issues."

In an official response to the audit, the staff of former NHCC chief Art Gianelli said billing practices had improved and that the hospital's procurement methods had sufficient oversight.

Nassau County Executive Edward Mangano, a Republican, ousted Gianelli last year and replaced him with Victor Politi, who has worked as a physician at NUMC and served previously as Nassau's acting police commissioner. Gianelli previously had served as deputy county executive for budget and finance under Democratic County Executive Thomas Suozzi.

NHCC operates Nassau University Medical Center, a nursing home and several health clinics.

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In the 2011 audit, Maragos found $6.5 million in patient charges were not billed to insurance providers or patients because of missing patient information and pre-billing errors.

The new audit, a follow-up, found billing errors had not been fixed and that NHCC was forced to write off $7.9 million in patient costs, including nearly all of the charges identified by Maragos in his original audit.

Maragos said NHCC leadership had a "cavalier attitude" toward fixing the billing errors.

NHCC said in its response that its rate of unbillable charges had dropped since 2009. It said the write-offs date back to 1999 and represent a fraction of the $1.4 billion in gross charges issued annually by the hospital.

The audit also criticized the hospital for allowing a $250,000 consultant contract to balloon to $4.5 million. While the original contract was competitively bid, six amendments were not.

NHCC said it would be "unreasonable" and "counterproductive" to competitively bid each contract amendment.

The review also found lax management oversight of non-medical employees' overtime, including three members of the hospital's engineering staff who earned more in OT in 2011 than they did in base pay.

NHCC said its total staff overtime was in line with other "productive hospitals."

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Maragos said he will issue a third audit on NHCC next year.In a statement Tuesday, Politi said the the comptroller's audit highlighted "the reason why I ordered a complete and thorough audit of the hospital's finances."