Sheriff May Have Overbilled for Care

Hindered by a haphazard system of medical record keeping, the Los Angeles County Sheriff’s Department appears to have overbilled the state by millions of dollars for medical care provided to state parole violators housed in county jails--including charges of $755 a day for inmates who received nothing more than medication in the jailhouse pill ward, according to a state report made public Monday.

The report prepared for the state controller’s office found numerous discrepancies in the sheriff’s billing procedures for a sampling of 200 state parole violators who were housed in the county jail system between 1993 and 1995. In nearly half of the cases reviewed, the department charged the medical rate--up to the $755 per day--when there was little evidence to support a rate other than the standard $51 per day for nonmedical inmates, officials said.

If the errors held true for all parole violators housed by the sheriff, the overbillings would exceed $10 million over the three-year period studied, according to senior legislative analyst Dan Carson in Sacramento.

Until some sort of agreement can be reached on the scope of the problem, the state is withholding $18 million in medical reimbursements owed to the Sheriff’s Department.

“The [controller’s office] found significant problems in documentation of invoiced items and identified substantial payments for housing inmates in pill wards, where prescriptions are dispensed but medical treatment is not provided,” the auditors wrote.

The concerns of the controller’s office were initially voiced more than a year ago, when a routine audit revealed that the sheriff’s medical billing practices appeared to be deeply flawed. A team of four independent auditors--including accountants and a registered nurse--was subsequently formed to comb through the medical records.

“It’s going to take some time to work this all out,” said Carson, who has studied the county jail system for the Legislature. “We’re a bit disconcerted to see these problems--going back years--where the state has paid claims that are clearly unsubstantiated. We’re talking millions of dollars.”

Sheriff’s officials acknowledge that the jail system is plagued by paperwork problems, but they question the findings of the state report, saying it is based on a statistically invalid sampling of cases.

“This department has been the subject of numerous audits during the last year,” Sheriff Sherman Block wrote in a rebuttal letter to the state. “This audit, in terms of scope, procedures, consistency and validity suggests the need for a review of your audit procedures.”

Undersheriff Jerry Harper said: “Frankly, we would like to have a more complete audit and go back and do a case-by-case look at the situation.”

In some instances, state parole violators who did not require medical care were placed in the medical wards simply because there was no place else to put them in the overcrowded jail system.

“We agree there have been errors, but I don’t know if it is to the tune of millions of dollars,” said Harper. “That’s where we have a disagreement. We don’t think the audit is as thorough as it should be.”

The cases the state team studied were randomly chosen from among about 800 state parolees in the county jails who are awaiting hearings or transportation to prison. Of the 200 cases reviewed, medical files for 70 inmates could not be found. Of the 130 files that were produced, 20% did not include adequate documentation to support the medical fees. What’s more, 46% of the cases studied involved inmates who only received pills instead of full medical treatment.

“In the so-called pill modules, the medical care provided was minimal, yet we are paying at a very high rate,” Carson said. “That suggests there is a need to tighten things up.”