OFFICE OF THE INSPECTOR GENERAL

BUREAU OF INTERNAL AUDIT

FLORIDA DEPARTMENT OF CORRECTIONS

FOLLOW-UP REVIEW OF HEALTHCARE – COPAYMENTS BY INMATES AUDIT
Paul C. Decker, Inspector General
Report # R06019F

Dave Mecusker, Chief Internal Auditor

BACKGROUND
The Healthcare – Co-payments by Inmates Program
was created in January 1995 by Florida Statute,
945.6037. It designated that a fee be collected for
non-emergency visits to a healthcare provider which
were self initiated by the inmate. Additionally, copayments may not be charged for the required initial
medical history and physical examination obtained
during the inmates’ indoctrination at the reception
center.
The current co-payment fee is $4 per visit and is
deducted from the existing balance in the inmates’
bank account. If the account balance is insufficient to
cover the co-payment, 50 percent of each deposit to
the inmate’s account must be withheld until the total
amount owed has been paid. Offender healthcare will
never be denied due to the lack of available funds.
The proceeds of each co-payment are deposited in
the General Revenue Fund.
During fiscal year 2003-2004, the Inmate Healthcare
Co-payment Program collected $452,815. During our
audit scope period from July 1, 2004 through February
28, 2005, $303,293 was collected.
OBJECTIVES
Our follow-up review objectives were to:
•

determine the corrective actions taken on
reported audit findings, and

•

whether actions taken are achieving the
desired results as intended by management.
SCOPE AND METHODOLOGY

Our follow-up review consisted of an interview with the
Acting Deputy Director of Administration, Office of
Health Services with regard to the original findings,
recommendations, and corrective actions for the
period of July 1, 2004 through May 11, 2006.
Additionally, we made inquiries of implemented
procedures and analyzed the follow-up actions taken.

July 18, 2006

RESULTS OF FOLLOW-UP
Our original audit, Healthcare – Co-payments by
Inmates, Report # A05013 issued on October 13,
2005 indicated that the program was functioning as
intended, however issues were identified that required
managements attention and if addressed would
further enhance the effectiveness and efficiency of the
Inmate Healthcare Co-payment Program. The Office
of Health Services has adequately addressed the
issues identified in our original report and has
taken appropriate actions necessary as indicated
in their follow-up responses below:
Finding 1 - To increase revenue generation and
provide consistency in collections, Health Service
Administrators should adhere to procedures
regarding co-payment charges.
Recommendation - We recommended that all
HSA’s and medical staff be required to review and
indicate in writing their understanding and
responsibility for adherence to DC Procedure
401.010.
Management’s Original Response - The Office of
Health Services agreed with our recommendation and
in a letter to the Regional Health Service Managers
(RHSM) indicated that an in-service review was to be
held with all medical staff involved with the application
of co-payments to ensure compliance with DC
Procedure 401.010. Additionally, during future site
visits, the RHSM will conduct a sample review of sick
call events to ensure that the co-payment designation
is correct and in accordance with procedure
Management’s Follow-Up Response – In order to
increase revenue generation and provide consistency
in collection, Health Services Administrators and other
associated health services staff have received
additional training on the provisions of DC Procedure
401.010 regarding the co-payment process.
Recurring inspections of this function are being
performed by the institutional Health Service
Administrators and are also included as an item of
interest during site visits conducted the Regional
Health Services Managers. To ensure consistency in
co-payment application the Regional Health Services
Managers select and review random inmate
encounters; review inmate grievances related to copayment; and question staff on their actions in this
regard. These actions appear to have improved the
consistency of correct co-payment application.

Finding 2 - To preclude a misunderstanding by
inmates of the Healthcare Co-payment Program,
the Co-payment Training and Instructions to
Inmates (NI1-001) poster should be displayed.
Recommendation - We recommended that all
HSA’s and medical staff be required to review and
indicate in writing their understanding and
responsibility for adherence to DC Procedure
401.010.
Management’s Original Response – The Office of
Health Services agreed with our recommendation and
in a letter to the Regional Health Service Managers
(RHSM) indicated that an in-service review was to be
held with all medical staff involved with the application
of co-payments to ensure compliance with DC
Procedure 401.010. Additionally, during future site
visits, the RHSM will conduct a sample review of sick
call events to ensure that the co-payment designation
is correct and in accordance with procedure and that
the display of the “Co-payment Training and
Instruction to Inmates” poster is appropriately
displayed.
Management’s Follow-Up Response – Institutional
health services staff have made an extra effort to
preclude misunderstanding by inmates of the copayment program. This has been accomplished by
re-emphasizing how co-payments will be applied
during intake processing,; during the actual medical
encounter with the inmates; in response to grievances
filed by the inmates, and by ensuring that the copayment notice, form NI1-001 (English and Spanish),
is posted in appropriate areas.

This follow-up review was conducted by James W. Crews and supervised by Donald L. Miller. Please address
inquiries regarding this report to Dave Mecusker, Chief Internal Auditor, at (850) 410-4168.