Vermont Seeks to Improve Management of Prisoner Medical Costs

by Derek Gilna

Vermonters have a well-deserved reputation for fiscal responsibility, so it is no surprise that State Auditor Doug Hoffer’s 2013 audit report detailing spending on Vermont’s in-state prisoners was critical of a $4.2 million deficit, over the past three-year period, out of total budget of $49.1 million. With respect to outside contractor Correct Care Solutions (CCS), Hoffer noted that “cost monitoring was not robust during the earlier years of the contract, but has improved since late 2012.”

Vermont’s contract with the company calls for a “cost-plus management fee” method of reimbursement, which the auditor feels gives the contractor no incentive to reduce costs. He also pointed to several instances wherein state officials could have been more diligent in recovering medical reimbursement when prisoners were covered by other insurance programs or by Medicare or Medicaid. The audit turned up one example where CCS failed to bill Medicaid for a prisoner’s medical procedure which cost the state $84,000.

The report was noteworthy for another reason; it made clear that adequate medical care for prisoners was a priority for Vermont. Vermont Director of Corrections, Dr. Dee Burroughs Biron, said, “Maybe they have diabetes or hypertension. I don’t think it’s fair to have them leave with less than adequate medication. Can we do better with getting those medications from a major pharmacy provider? We use to do that and we are going back to that, but the important bottom line is that people are getting their medication. I think I try to balance the cost with the care that is provided.”

Dr. Burroughs-Biron also conceded that perhaps there were errors in overseeing the program in the early years, but that prisoner health care had not been compromised as a result: “Overall, we agree that in terms of the monitoring early on, it could have been more intense or robust.” She did note that there were only six people assigned to monitor the entire health-care services department, who are housed in eight different facilities, but lauded their efforts. “All our providers are Vermonters, and they are working their rear ends off to do a very good job to serve the corrections population.”

The auditor’s report recommended “short-term cost containment and monitoring improvements related to medications and insurance as sell as longer-term recommendations, including using a more cost-effective contracting type than cost-plus management fee.”

Sources: Associated Press, http://auditor.vermont.gov