DPSCS audit reveals $1B medical contract issues with Centurion and staffing shortages

In a recent session of the Maryland General Assembly's Appropriations Committee, significant concerns were raised regarding the Department of Public Safety and Correctional Services (DPSCS) following a November 2024 fiscal compliance audit. The audit, conducted by the Office of Legislative Audits (OLA), identified nine critical findings related to DPSCS's medical contracts and procurement practices from April 2018 to December 2023.

One of the most pressing issues highlighted was the agency's decision to award two substantial contracts to Centurion of Maryland for medical and mental health care services, totaling approximately $1.69 billion over five years. This decision came despite Yes Care, the previous contractor, offering a lower bid. DPSCS justified the switch by citing Centurion's superior technical ranking and anticipated local economic impact, alongside ongoing issues with Yes Care's performance, particularly in staffing and compliance.

The audit revealed that DPSCS's previous contract with Yes Care utilized a fixed fee payment model, which has been criticized for its inefficiency. This model, which pays contractors a lump sum upfront, has led to increased costs—$48.7 million from fiscal years 2018 to 2023—despite a nearly 20% decline in the average daily corrections population. Concerns were raised about the lack of documentation supporting DPSCS's claims that this payment structure was based on a survey of other states, as OLA found that such models are not commonly used elsewhere.

Staffing shortages have also been a significant issue, with Yes Care reportedly filling only 81% of necessary positions each month. The audit indicated that DPSCS failed to address these staffing challenges adequately, leading to ongoing issues in service delivery. As of January 2025, Centurion's staffing levels were similarly low, with only 70% of positions filled.

Moreover, the audit pointed out serious lapses in monitoring contractor compliance with medical intake and examination protocols. DPSCS did not ensure that individuals in custody received timely medical evaluations, which poses risks to their health and increases the agency's exposure to litigation. The audit also criticized DPSCS for inadequate financial management, including the approval of significant settlements without proper oversight.

In response to the audit findings, DPSCS has committed to improving its oversight processes and developing corrective action plans. However, the effectiveness of these plans remains uncertain, as the agency has not provided updates on their implementation. The committee has recommended budget language to restrict $500,000 pending a report on how DPSCS plans to address the audit's feedback.

Additionally, the meeting addressed ongoing staffing challenges within DPSCS, particularly concerning correctional officers (COs) and community supervision agents. The agency has experienced net losses in CO positions for nine out of twelve months in 2023 and 2024, with current vacancy rates standing at 10.8% for COs and 13.4% for administrative roles.

The discussions during this session underscore the critical need for DPSCS to enhance its operational oversight and address staffing shortages to ensure effective service delivery and compliance with health care standards. As the agency moves forward, the implementation of corrective measures will be closely monitored by the General Assembly and the public.