Mills County Named In Ombudsman Report On Collection Of Inmate Health Care Costs

Mills County was one of four counties named in a report released last week by the Iowa Office Of Ombudsman concerning the collection of money for jail inmate health care costs.

According to the report, some of Iowa’s county jails have collected money from inmates for health care costs before the inmates are convicted and without a court order, in violation of Iowa law.

The report says Iowa law requires jails to provide necessary care to inmates for objectively serious medical and dental needs. County sheriffs are allowed to recover the costs from inmates, but only if they are found guilty and only after a bill of costs is presented to a court and approved.

The report focused on jails in Mills, O’Brien, Wapello and Scott counties where the Ombudsman verified that inmates had been charged improperly. A survey of eight other jails found similar issues in six of them.

In Mills County, investigators found that the jail had taken the funds in 2020 for medical costs that the inmate had incurred during incarceration. The jail, however, had not filed a reimbursement claim consistent with Iowa Code section 356.7. This was not an anomaly for the jail, as it regularly pursued this recoupment process for medical expenses.

The then-jail administrator said Mills County took inmates’ money for medical-related charges because, otherwise, the county would receive little or no money for those services. She told investigators she believed inmates with medical needs should not be allowed to buy commissary products, as they would “spend their last dollar on a candy bar” and the county would receive nothing.

At the time, the county did not pursue room-and-board charges like it had in this case for medical expenses. Instead, the county would recoup room and board only after an inmate had been sentenced and the county attorney had filed a reimbursement claim in district court. In this case, the county had filed a reimbursement claim for room and board in district court for $5,880.

Mills County has updated its practices, according  to the report. According to the office manager for the Mills County Sheriff’s Department, the county no longer deducts any money from any inmate account for reimbursement of medical-related charges.

When someone is leaving the jail after being sentenced by a judge, jail staff present that person with a form showing the amounts they owe for both medical-related charges and room and board, as well as a proposed payment plan. The first payment is due on the first day of the following month. If they do not make that first payment, the county then sends the paperwork to a private collection agency that Mills County has contracted with for recoupment of unpaid jail fees.

The private collection agency then pursues collection on the county’s behalf. The office manager told the Ombudsman office that over the past two years, the vast majority of clients honored their payment plans. For those who do not honor their payment plan, the private collection agency files a reimbursement claim in district court on behalf of Mills County.

The report said the main goal of this program is to persuade people who have been sentenced to voluntarily make payments so there is no need to go to court. The Mills County office manager said they do not pursue recoupment for any jail fees from inmates who were not convicted.

Among the 12 county jails contacted, the Ombudsman said Mills County is the only county now found to be in general compliance with section 356.7, having changed its practice after the investigation.

The office manager said she gave a presentation on Mills County’s recoupment process to a large group of officials from at least 50 other counties. Based on the feedback she received, she believes some of those counties may be adopting those same procedures for their own recoupment efforts.


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