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Florida Department of Corrections
Nov 5, 2016 politico.com
Audit raises 'grave concerns’ about mental health treatment for inmates at central Fla. prison
TALLAHASSEE — State auditors, reviewing prisoner medical records at a central Florida prison, found widespread compliance problems in providing mental health treatment to prisoners and “confirmed grave concerns about the administration of medications.”
"This review indicates serious and multiple deficiencies in the delivery of mental health care in both the inpatient and outpatient settings at Union Correctional Institution,” the report states. Auditors looked through 19 medical records of Union prisoners and found only one who received his medication as prescribed over a several months in 2015. The state's prison medical oversight agency, the Correctional Medical Authority, found prisoners had not received one or more doses of their medication or, in some case, received the wrong dose. The CMA also found that in two separate instances, involving the use of psychiatric restraints, vital requirements were either not followed or not documented as required. That included failing to check whether the patient was still breathing and had a pulse. In another instance, two prisoners described to auditors a case where a prisoner tried to alert guards that he was having a “mental health emergency,” but was ignored for several hours until he attempted to hang himself. Auditors found the prisoner had recently been placed on suicide watch and referred to a crisis stabilization unit after trying to hang himself, and their review of his health records revealed “several concerning issues.” They further found that the prisoner didn't receive any of his medications in the first two days after he was discharged from a medical transitional care unit. In the case of the same prisoner, auditors found no documentation that the discharge was properly authorized and that, despite plans two weeks later for a follow up evaluation with a psychiatrist, he never saw one — even though his anti-psychotic medication dosage had been increased. In addition to not seeing a psychiatrist, the auditor found he was discharged a month later without any documentation that his case manager had seen him. The audit also noted "significant compliance issues in the areas of laboratory tests, medication consents, and Emergency Treatment Orders." Overall, the auditors wrote that their review “indicates serious and multiple deficiencies in the delivery of mental health care in both the inpatient and outpatient settings at Union Correctional Institution." Five months later after their initial review, auditors checked in on the prison again to see if the department had followed the “corrective action plans” to fix the problems. Their findings: Almost two-thirds of the issues “remained deficient,” including making sure inmates receive their medication as prescribed. "[The Florida Department of Corrections] is committed to making certain all inmates incarcerated in Florida are given comprehensive health care services,” Michelle Glady, a department spokeswoman, said in an email. "While health care within the Department’s institutions is privatized, FDC closely monitors these services to ensure any deficiencies or necessary improvements are being adequately addressed.” She noted that when auditors conducted their follow-up, the department was about to transition private healthcare providers from Corizon, which decided to walk away from its $1.2 billion contract with the department more than two years early, to Centurion, which got the contract to complete the term for Corizon’s contract. DOC staff did their own follow up review in August. Of the 49 deficient “corrective action plans” during the CMA review in April, 28 were still deficient, the department found. Though inmates are now receiving medication as prescribed, the department’s review found there are still several deficiencies when it comes to placing prisoners in psychiatric restraints and checking the pulse and breathing of these prisoners while they’re restrained. Such requirements are in place to prevent prisoner deaths, which are associated with the use of restraint devices in prisons.

Florida Legislature
Feb 13, 2016 tallahassee.com
Lawmakers criticizing prison health contract
Lawmakers are expressing reservations over the Department of Corrections deal with a Florida company to provide health care in its prisons, saying it wasn’t fully vetted or formally bid and includes provisions that could drive up costs. Sen. Greg Evers, chairman of the Senate Committee on Criminal Justice, said Thursday he was surprised to learn of the contract with Centurion of Florida, which the agency entered into two weeks ago after its current vendor, Corizon Healthcare, walked out early on its five-year contract. Centurion will be paid a maximum of $267.9 million a year to provide health care to 82 percent of the state’s inmates in prisons throughout Central and North Florida, including the Big Bend, where Corizon operates for now. The “cost-plus” contract pays the company for its actual costs, like salaries and benefits, and gives it an additional payment of 13.5 percent of its costs, for overhead and profit. Though the agency says it’s unlikely to happen, Centurion could get more than $30 million a year in fees and profits. “Anytime you get caught in a situation where you’re paying cost-plus, I don’t think that’s a good deal,” said Evers, a Republican from Baker. “Because the more you spend, the more you make.” In other developments, DOC on Thursday rejected a move by another of its prison health vendors, Wexford Health Services, challenging the agency’s selection of Centurion. Wexford last week notified the department it would file a bid protest. But DOC dismissed the filing, saying the agency didn’t have to follow a competitive process under state procurement laws because the contract involved health services, which are exempt under statutes. The agency, however, gave Wexford until Wednesday to file an amended petition. DOC defended its handling of the Centurion contract in an email, saying the company’s price was tens of millions of dollars lower than those offered by Wexford and Armor Correctional Health Services, a third company involved in the negotiations. The agency said that while it didn’t follow a formal competitive process, it fostered competition in its negotiations with the companies. “When Corizon chose to terminate their contract early, the department was forced to find a temporary health care solution that was both fiscally responsible and focused on ensuring continuity of quality care for our inmate population,” said DOC spokesman McKinley Lewis. “Looking forward, the department remains focused on negotiating and securing permanent contracts which prioritize quality care for our inmates at a reasonable and affordable rate for the state of Florida.” Evers, however, said the 13.5 percent payment for fees and profit is too high. And he said he has other problems with contract, including a provision allowing Centurion to terminate with only two months notice. Corizon’s contract requires six months notification before it can terminate, which it exercised in November. He said that in a recent meeting with DOC Secretary Julie Jones, he voiced support for an idea to bring medical care to rural Florida prisons through small, community hospitals, which he said are hurting financially. He suggested the agency conduct a pilot program, possibly including telemedicine, to improve care and keep down costs. “Here I find out that we have entered into a contract but yet we haven’t fully vetted what I had discussed with her,” Evers said. “I feel like there should have been alternatives looked at before you would have entered into a contract such as this.” Lewis said DOC is examining the concept of pairing rural prisons with community hospitals. If it’s a viable option, the department will consider it as it continues looking for long-term prison health vendors. The agency last year began a lengthy, formal process to secure vendors and is expected to award contracts next year. He also said the agency fully vetted Centurion, a St. Louis-based company that operates in five other states. "We contacted other states that they are currently operating in as well as other references that they provided," Lewis said. "We found that they had an outstanding track record.” Evers last year ordered Jones to renegotiate its contract with Corizon following media reports on problems including suspicious inmate deaths, questionable care and staffing shortages. Last year, 354 inmates — a record number — died in Florida prisons. House Democratic Leader Mark Pafford of West Palm Beach said the push for privatization, which began several years ago under Gov. Rick Scott, hasn’t improved conditions. “I think they went so far in this habit they have of privatization and loosening regulations, and they did that I think to attract the private sector into their prisons,” he said. “And now look what they’ve got — a mess on their hands.” Corizon, which had a five-year, $1.1 billion contract, will end its work for the state May 31, two years sooner than expected. Centurion is under a two-year “gap” contract, though there are options to renew it for three more years. Florida TaxWatch on Thursday issued a statement calling for greater scrutiny of the Centurion contract, noting that DOC is facing “terrible funding issues that have put hard-working officers in dangerous situations.” “Our elected officials must demand a full and transparent explanation on how this decision will best serve and protect Floridians,” said Dominic Calabro, president and CEO of the watchdog group. “It is very difficult for Floridians to believe their interests are being protected by the decision to spend hundreds of millions of dollars without any competing bids or public debate.”

Feb 3, 2016 miamiherald.typepad.com
Corrections agrees to temporary new contract with prison healthcare company, Centurion
A company that provides prison healthcare services in five other states, announced Monday that it has signed a contract with the Florida Department of Corrections to fill in the gap in coverage after Corizon Healthcare terminated its agreement with the state last fall. Centurion of Florida, LLC, a joint venture between Centene Corporation and MHM Services, Inc., announced it has signed a formal agreement to begin in April to replace Corizon Healthcare as the medical provider in Florida's prisons beginning in the second quarter. The company's lead lobbyist is former House Speaker Dean Cannon, and its parent company, Centene Health, is a primary provider of managed medicaid services in Florida -- doing business as Sunshine Health -- and one of the largest contributors to legislative political committees in the state. Centene gave $298,000 to legislative campaigns and political committees in 2015 alone. Centurion currently currently has five has statewide contracts to provide correctional healthcare services, though none in a state as large as Florida. They are in Massachusetts, Minnesota, Mississippi, Tennessee and Vermont. Corizon Health decided not to renew its $1.1 billion contract with the state in November after months of complaints about inadequate inmate healthcare and dozens of lawsuits. A year ago, state Sen. Greg Evers, R-Baker, chairman of the Senate Criminal Justice Committee, ordered the Department of Corrections Secretary Julie Jones to renegotiate the Corizon contract after a series of reports in the Miami Herald and other news organizations showed suspicious inmate deaths were covered up or never reviewed, staffing was inadequate, and inmate grievances and complaints of harmful medical care were dismissed or ignored. Centurion's press release said the company will serve 70,000 inmates in the new prison Regions 1, 2 and 3, for a contract that runs through January 2018, when the agency expects to complete negotiations for a longer-term health care provider. Wexford Health Sources will continue to operate in Region 4, which includes Miami-Dade and Broward, during that time. Details of the contract, and what kinds of performance measures will be included, have not yet been released. Jones said in a statement that the agency “looks forward to working collaboratively with Centurion of Florida and Corizon Health to ensure a seamless transition of health care services for our facilities.” She said the department is committed to providing “quality health care to those in our custody and improving health outcomes for Florida’s inmates.” "This agreement with Centurion is a result of the state undertaking negotiation of a gap contract due to early termination by its prior vendor,'' Centene Corp. wrote in a press release. He said “the agreement also includes optional renewal periods if the formal procurement is not finalized in the anticipated timeframe.” Steven H. Wheeler, CEO of Centurion, said the company is “pleased to be able to work with the Department to improve the quality of services and care levels provided to this population. We also recognize the importance of maintaining sound financial discipline on behalf of the State and its residents.”

July 16, 2013 correctionsone.com

NASHVILLE — A legislative watchdog group agreed Monday to delve deeper into the state Department of Correction's awarding of a $200 million-plus contract to handle inmate health care to a relative newcomer despite its $6.4 million higher bid. Fiscal Review Committee members want the winner of the contract, Centurion LLC, to come before the panel in September. Correction Department officials went before Fiscal Review for approval of their request to extend the current contract of Brentwood, Tenn.-based Corizon until Sept. 30 to provide Centurion additional time to prepare taking over the service. While the business at hand was the 90-day extension of Corizon's existing contract, committee members devoted most of their time questioning Centurion's winning of the new three-year contract. Corizon, which had the existing contract, lost the competition to Centurion on the new three-year contract. Corizon protested but two state panels upheld the award to Centurion, the most recent coming in a June 6 ruling. Recently, Correction Department officials said, Corizon indicated it would not push the protest further by going to court. Lawmakers criticized the request-for-proposal process and raised concerns about the higher cost and what they see as the recently created Centurion's relative lack of experience. Rep. Tim Wirgau, R-Buchanan, said it raises "red flags" for him. "Give me some reasons why you decided to spend $6.4 million more," he told Wes Landers, chief financial officer for the Correction Department. Rep. Jeremy Faison, R-Cosby, was highly critical of Centurion's experience. "That seems a little shady there," Faison said, adding that the state either had standards or not in awarding points in the request-for-proposal process for experience. In remarks both during the committee and afterward, Wes Landers, the Correction Department's chief financial officer, defended the decision to go with Centurion. Centurion is a relatively new joint venture between MHM Services Inc., which has a track record in inmate mental health care, and Centene Corp., which specializes in managed care. The RFP allowed for "unique" ventures as the state seeks to cut its costs on inmate health care, Landers said. Between MHM and Centene, the experience requirement was met, Landers said, noting MHM has a history of work in Tennessee. Centene, he said, has cost-containing agreements with a number of hospitals in the state. The remarks about the RFP allowing room for "unique" ventures prompted Faison's remark about "shady" requirements. Landers later said in an interview that through Centene, Centurion will be able to pay the hospitals at Medicaid rates, which are cheaper, for inmate care. He said the company also has provided for a risk-sharing model that financially rewards the state for holding down unnecessary hospital visits. "I've got really high hopes for what we might be able to do," he said. Landers said under the RFP process, the decision is based on three factors: cost, the proposal itself and experience. Cost accounts for 35 percent of the decision while the technical proposal accounts for 45 percent and 20 percent is based on a firm's experience. Following the initial RFP, General Services' Central Procurement Office took over and continued negotiations with both firms to reduce costs. Landers said after all was said and done, Centurion had a six-point advantage despite Corizon's lower costs. Corizon's initial offer was around $229 million while Centurion's was $247.3 million, Landers said. After several rounds of negotiation, Corizon ended up at $225.6 million while Centurion was $232 million. Last month, eyebrows were raised after The Tennessean reported that Correction Commissioner Derrick Schofield's wife works in a midlevel capacity for Centurion in Georgia. Officials said there is no conflict and that Schofield recused himself from involvement in the awarding of the contract. Corizon, meanwhile, has had problems in other states with allegations the company's inmate care was inadequate. Kentucky television station WHAS reported it found "multiple wrongful death lawsuits" filed against the company, including one involving an inmate's death in the Lexington-Fayette County jail in 2012. Landers said Tennessee has assessed the company $37,000 for several problems, including failure to maintain adequate staffing and failure to perform tuberculosis skin tests on inmates. The Fiscal Review Committee granted the department's 90-day contract extension for Corizon. Landers said it was necessary because of delays caused by the bid protest with Centurion unable to come in to begin planning until the issue was settled.

New Mexico Corrections Department
Jun 5, 2016 santafenewmexican.com
Centurion lands contract after supplier’s wife helped craft specs
A consultant who helped write the New Mexico Corrections Department’s request for proposal on a $41 million health care contract also has ties to a business that sells medical supplies to Centurion, the company that received the contract. The consultant, Ann Perham, is married to Jonathan Perham, owner of Axess Medical LLC, a Middleton, Mass., company that sells medical supplies to prison health care providers, including to Centurion for its contract in Massachusetts. She said there was no impropriety in her helping to craft the proposal soliciting companies to provide health care for 7,200 prisoners in New Mexico. But one of the phone numbers Axess lists on its website leads to a voicemail recording by Ann Perham, who is also the signatory of the company’s records. Perham billed the state 44.75 hours of work at $200 an hour and requested a payment of $8,950 to be sent to her Massachusetts home. The phone and fax numbers on Perham’s invoice are the same as her husband’s medical supply company. Axess incorporated in Massachusetts in 2009 to “provide procurement services to private companies and institutions for medical supplies, medical equipment and healthcare products,” according to its website. Ann Perham said she disclosed to the New Mexico Corrections Department the relationship between her and her husband’s business. Perham said in a brief telephone interview that she works with different companies as a consultant. She would not disclose the names of the companies. “There’s no conflict of interest. It was a basic RFP,” Ann Perham said, using the acronym for request for proposal. Ann Perham and Alex Tomlin, a deputy secretary of the Corrections Department, said in separate interviews that Axess will not supply Centurion with medical equipment for its New Mexico contract. Neither could say where Centurion would purchase equipment. Mike Brewer, senior vice president of corporate development for Centurion, did not respond to questions emailed to him last week. Tomlin also told The New Mexican she thought Axess Medical also had a business relationship with one of the other bidders on the New Mexico medical services contract that Centurion won. But spokeswomen for the other two bidders on the contract, Wexford Health Sources and Corizon Correctional Healthcare, said in emails Friday they have no record of ever doing business with Axess Medical. This would indicate that Jonathan Perham’s company had a relationship only with the successful bidder of the contract for which his wife wrote the specifications. Tomlin said the state’s hiring of Ann Perham was a wise move because Perham is in the prison health care industry and understands how to write the specifications of how a private company would care for inmates. “It’s a very small world, medical contract vending for prisons, and we were trying our damnedest to make the best deal for taxpayers and not leave anything out,” Tomlin said. “We said, ‘We are not the expert. Let’s go find the expert to help us write the medical contract. Tomlin said the department found that expertise in Ann Perham, a former vice president of Corrections Medical Services Inc., but not before it had already hired and then rejected a separate consultant. The Corrections Department gave the job to Perham after it had first hired Jacqueline Moore & Associates,a Colorado-based firm. The state on Jan. 4 paid Ann Perham $8,950 for helping to write the 190-page request for proposal, according to a copy of the check turned over by the Corrections Department. Jacqueline Moore said she was never paid for the time she spent preparing the RFP. Rather, Moore said, Angela Martinez, the Corrections Department’s health services administrator, told Moore her “services were no longer needed.” Martinez told Moore she was in discussions with potential bidders on the contract, Moore said. State rules on contract bidding outlaw certain communications between the state and bidders. Such laws are meant to prevent one company from having an edge over competitors. “I told her she really shouldn’t be doing that,” Moore said. “There should be a cone of silence once the RFP process has started, and you should not have RFP conversations with anyone else. And it was from one of the vendors that she got the name of the consultant she used. The vendor was Centurion.” Tomlin says otherwise. “There was not communications with vendors,” she said, adding that the department did not know what companies would bid on the contract when the state was writing the request for proposal. Tomlin said the state entered into a contract with Moore, then rejected her. Tomlin would not explain why. As for Moore’s allegation that the process was improper, Tomlin said only one official in the department was authorized to speak to the three companies that bid on the health care contract that Centurion won. Tomlin said there was a directive that prohibited state employees other than Lori Vigil from communicating with the bidders. Vigil is General Services bureau chief of the Corrections Department. Moore insists that Martinez had communications with Centurion. Moore said that she called Centurion herself when she was working on the proposal for bids. She said she requested data from the company. “The RFP was not released at that time, but she was talking to vendors,” Moore said of Martinez. “She was talking to Centurion. We were working on the RFP and when I start to work on a project at that point I don’t talk to vendors, you know, and neither does anyone else from the … state. It’s just not ethical. I mean you just don’t give someone else an unfair advantage.” Moore said the department never paid her for about $8,000 in work. She said she would like to resolve the issue “amicably” rather than through a lawsuit. The Corrections Department signed a contract with Ann Perham in November. It called on Perham to “perform technical RFP writing and due diligence services” for the department for 40 hours at a rate of $200 an hour. She eventually billed the state for nearly five additional hours. It specified that Perham would assist the department in preparing performance on contract-issues that included penalties, sanctions, cost proposal sheets, Medicaid and staffing requirements. Tomlin said the Corrections Department was satisfied that Perham had identified her husband as being in the business of supplying goods to prison health care providers. “As far as NMCD is concerned, our position was, ‘Yes, she made the disclosure,’ ” Tomlin said in reference to Perham. “And we were aware.” The request for proposal served as the basis for bids submitted to the state by three companies in the prison health care industry. After a six-month competition for the contract, the Corrections Department this month awarded Centurion both contracts to provide both medical care and pharmaceutical services that are worth a combined $52 million. Corizon, the state’s former inmate medical care provider whose contract expired last week, was not selected, despite earning a higher technical score and offering a lower bid, according to the company’s spokeswoman. Corizon lost the bid a month after a six-month investigation by The New Mexican that raised questions about the quality of care the company provided to inmates

Tennessee Department of Corrections.
Oct 30, 2016 tennessean.com
After jail cell birth, Nashville inmate files suit
An inmate who gave birth inside a cell at the Tennessee Prison for Women has filed suit, alleging nurses and a doctor “alternately ignored and only occasionally checked on” the pregnant woman during four hours of labor. The inmate gave birth inside a cell in the prison’s medical wing without a qualified OB-GYN, in non-sterile conditions and without pain medication, according to the lawsuit filed against Centurion, a private company that contracts with the state to provide prisoner health care. The lawsuit also names Dr. Donald Bruce, a doctor employed by the company. The newborn was wrapped in a “dirty towel or cloth and his umbilical cord was cut with a non-sterile object,” the lawsuit said. The infant boy eventually spent five days in the intensive care unit of Nashville General Hospital at Meharry with a severe infection after his birth on July 17, 2015. The lawsuit accuses Centurion nurses of telling the inmate she was “faking it” during her labor. The woman was nine months pregnant at the time and prison officials were aware she was near her due date, the lawsuit said. “It’s shocking,” said attorney Michael Smith, who is representing inmate Amanda Lemka. “It boils down to an indifference and lack of care for patients there. Instead of treating her like a human being, they instead acted like we live in a Third World country.” Lemka remains in prison over a parole violation for a nonviolent crime, said Smith, who declined to specify her crime or her sentence. A spokesman for the prison did not respond to a request for information about the prisoner by the newspaper's deadline. The prison is not named in the lawsuit. Neither lawyers for Bruce or Centurion responded to a request for comment. The lawsuit, filed in September in Davidson County Circuit Court, comes after scrutiny of the medical services provided at the Nashville prison — and a series of controversies at the Tennessee Department of Correction. In October, Centurion’s health services administrator and the regional health administrator were removed from their positions at the women's prison after an audit revealed that medications were not being given out in a timely manner. In addition, the top three wardens at the facility were demoted or retired over “concerns” about the effectiveness of their leadership, including their failure to manage the medical contractors. Additionally, two inmates filed a federal lawsuit seeking class-action status against the state and Centurion earlier this year alleging inadequate treatment of inmates with hepatitis C. The lawsuit follows a Tennessean investigation into the treatment of hepatitis C in prison, which revealed thousands of inmates have the potentially life-threatening liver disease but only a rare few receive the costly but effective treatment. The department argued that regularly testing an inmate’s blood amounts to treatment, but experts say that will do nothing to actually cure inmates of the disease. The Department of Correction is in the process of seeking bids for the prison health services contract that is currently with Centurion, a contract likely valued at more than $200 million. It’s unclear if Centurion will submit a bid to keep the contract, or how an additional lawsuit could affect the company’s chances of again earning the contract. The lawsuit alleges that after the birth, nurses refused to allow the mother to hold or have contact with the newborn infant, instead passing the baby around to other staff in the cell. Lemka was diagnosed with post-traumatic stress disorder and depression after the events surrounding the baby's birth, according to the lawsuit. The 1-year-old baby lives with his father and is in good health, Smith said.