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Nassau, NUMC dispute health care bills for county jail inmates

This aerial view shows the Nassau University Medical

This aerial view shows the Nassau University Medical Center (NUMC) and Hempstead Turnpike in East Meadow. Credit: P. Coughlin

Nassau County and Nassau University Medical Center are embroiled in a dispute over tens of millions of dollars the county owes the public hospital — the bulk of it for health care for inmates at the county jail in East Meadow.

NuHealth, the public benefit corporation that runs NUMC, has said Nassau owes the public hospital more than $25 million  for inmate charges for hospitalization, as well as payments for utilities and benefits for NUMC retirees.

County officials have said the outstanding balance could be millions of dollars less, and have offered a $16.6 million payment. George Tsunis, the outgoing NuHealth chairman and interim chief executive and president of NUMC, called the offer “a major step forward,” but said, “we’re still negotiating.”

Tsunis said when "we aren't timely compensated … it adds further financial stress to a situation that's pretty financially stressful to begin with."

The dispute, which has lasted more than a year and involves bills dating to 2012, comes as both the county and NUMC struggle with budget deficits and heavy debt loads. 

The Nassau Interim Finance Authority, a state board that controls Nassau's finances, said recently it was exploring whether to oversee the hospital after the NuHealth board approved raises for more than 3,000 employees.

NuHealth, with a $587.6 million budget, in 2018 posted a $46.6 million operating loss, according to their audited financial statements.

Nassau, with a $3 billion budget, had a $61.2 million deficit in 2018, according to NIFA.

County officials have spent months trying to determine the scope of the billing problems.

Earlier this year, Nassau County Executive Laura Curran directed administration budget officials to review the payment backlog. Officials found claims filed by NuHealth that lacked required federal 1099 tax forms or proof of disability. They said they also found duplicate payments and claims for deceased persons.

County officials also denied $1.48 million in hospital claims — under the category of retiree benefits and termination pay — because NuHealth permitted "excessive leave usage prior to retirement."

Curran, a Democrat who took office in 2018, blamed the billing issues on the administration of former GOP County Executive Edward Mangano and past hospital administrators.

“Because the prior administration at the county and the hospital stopped doing the work, and totally dropped the ball, it took a while for us to figure it out,” Curran said in an interview. “But we were both committed to figuring it out and making sure the hospital got what it was due.”

The primary dispute concerns what Nassau owes NUMC for treatment of county inmates at NUMC, which abuts the jail campus in East Meadow.

NuHealth officials have said Nassau owes:

  • Some $11 million for inmates treated at NUMC, dating to 2016.
  • $9.9 million for utility bills at county facilities.
  • $7.4 million for health benefits for NUMC retirees.

Nassau jail inmates can incur health care costs at two locations — at the jail or for hospitalization and outpatient care at NUMC.

Monthly installments of $1.75 million for on-site care at the jail are up to date, officials said.

But there is no limit on payments for inmates who are treated at the public hospital.

Ray Orlando, deputy Nassau County executive for finance, said, “over time, the hospital was sending bills to the county, and I don’t believe the county was actually engaged in the necessary work to review them [and] get them approved.”

“There was insufficient follow-up, it sounds like, on both sides," said Orlando, whom Curran detailed to sort through the dispute.

"The hospital … wasn’t responsive to the questions that were being raised by the various folks in a way that allowed for the issues to be resolved," Orlando said. "Nor were the staff people on the county side following up at a high enough level to resolve the issues before they start accumulating like the planes on the tarmac.”

"The monthslong effort has been a long, complicated slog of everybody hashing through numbers and details together," said Nassau County Comptroller Jack Schnirman, whose office denied or found errors in a number of claims NuHealth submitted.

"The longer that money is out there, the less money I have to pay salaries, vendors, and everything else,” said John Maher, NuHealth's chief financial officer.

But Orlando said in an interview, “I don’t think that it’s appropriate for us to pay bills that we don’t ourselves believe we owe.”

NIFA Chairman Adam Barsky said both the county and NUMC, “are under fiscal stress, both of them need to make sure what they owe is collected and what they owe is accurate. I think both sides wanted to make sure they were being treated fairly.”

Orlando said the settlement would "resolve our claims forever," and requires approval by the 19-member Nassau County Legislature.

Tsunis said the hospital and the county have worked "in a constructive manner to rectify the situation."

He continued, "by constructive, it's not to say that the county and the hospital did not fight tooth and nail for every last dollar, and it was a tough negotiation, and I respect both sides for being respectful of taxpayer dollars. But it seems that we finally turned the page, and an equitable solution is in reach."

Said Curran: "Every problem has a solution. Some problems are a little more thorny than others."

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