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Oklahoma County detention center faces budget strain as medical contract costs rise; trustees receive report
Summary
Budget officials reviewed a presentation on rising medical costs at the Oklahoma County Detention Center, including a switch from Turnkey to in‑house/Heritage billing that raised projected off‑site medical costs and prompted calls for an audit. The board voted to receive the report and place the item on a fiscal watch list.
Greg Couch, chief director of technology for the Oklahoma County Detention Center, told the Oklahoma County BET during a special meeting July 1 that the jail’s medical and off‑site care costs have risen sharply since the county ended a contract with Turnkey and moved some services in‑house.
“We requested for fiscal year 25, our total is 42,100,000.0. And for the fiscal year, we were approved for 33,700,000.0,” Couch said, describing a multi‑million‑dollar gap his office is trying to reconcile. He told trustees that the county previously paid a Turnkey contract that included about $8.1 million for salaries and medical services plus roughly $840,000 for off‑site medical bills. After moving services in‑house and contracting billing to Heritage, Couch said the comparable annualized off‑site projection rose to about $4.52 million, producing a $3.13 million difference on an annualized basis.
Why the Heritage figure is far higher than the prior $840,000 projection remains under review. Couch said staff are going through Heritage’s and Turnkey’s billing records to determine whether some charges were for preexisting conditions or other items the county should not have paid under state law: “We have to go through all of Heritage's billing, all of Turnkey's billing to determine if Heritage overpaid or paid things that we were not responsible to pay,” he said. “We may have overpaid, but I don't know that. We don't know that yet.”
Trustees and county finance staff pressed for details on staffing and contract escalation terms. Members asked how many full‑time equivalents (FTEs) Turnkey was funded for (70.8 FTEs in the contract, Couch said) and how many staff actually transferred (about 63). Trustees also sought the escalation percentage in the Turnkey contract and asked Couch to provide part‑time staffing counts and Heritage’s contract terms.
Couch presented a cash‑flow snapshot showing the detention center began the fiscal year with a carryover the presentation listed as $2.1–$2.5 million (the figure was discussed and clarified during the meeting). County finance staff said the jail had about $2.39 million in cash on June 13 and expected to use roughly $1.3 million to pay June invoices submitted the following week. Trustees and finance staff agreed the immediate situation did not mean the jail would be unable to operate on Aug. 1, but several members emphasized the risk that, if current projections hold and the payroll assumptions assume full staffing for 12 months, the jail could face a multi‑million‑dollar shortfall by the end of FY26.
County finance staff and trustees recommended treating the FY26 shortfall as a watch‑list item to monitor monthly and requested additional breakdowns: an FTE roster separating custody/detention positions from medical staff, exact amounts paid to Heritage to date versus projected annualized payments, the amount actually paid to outside providers so far, and any contract escalation provisions. Trustees also urged legal review and recommended a forensic audit of Heritage and Turnkey billing to determine whether the county was billed for services it is not legally responsible to pay.
Trust members and jail managers discussed operational impacts, including difficulties scheduling community providers for off‑site follow‑ups when payment history is uncertain; clinic and emergency‑level care needs that exceed on‑site capabilities; and the county’s ongoing use of contract staff (VHS contractors) to cover custody functions while recruiting detention officers. Trustees noted that contractor costs can exceed the budgetary savings from vacant salary lines and asked for a clearer mapping of the detention center’s staffing picture and how contract expenses are being funded from salary savings.
At the end of the presentation, the BET moved to receive the report. The motion passed by voice vote. Trustees said they will revisit the item in their regular September budget cycle and will add a watch‑list item for the detention center’s FY26 fiscal exposure while staff complete billing reviews and any recommended audits.
