CBS 4: Critical Condition: Jackson Memorial Hosptial

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Miami (CBS4 I-Team) - Few institutions are as vital to South Florida as Jackson Memorial Hospital.

When Miami Dade Police Officer Robert Gonzalez was injured in 2008, he was brought to Jackson where doctors saved his life. When Michael Brewer was set on fire by a group of teenagers last year in Deerfield Beach, he was airlifted to Jackson's burn unit where he made a remarkable recovery. And last month when the first Americans were pulled from the rubble in Haiti, they too were flown to Jackson.

Every day Jackson plays a role large and small in the community. But as a public hospital its most important role is to provide care for those who have nowhere else to go.

In essence, Jackson is South Florida's safety net, but that safety net is in jeopardy because Jackson Memorial Hospital is running out of money. In a matter of weeks, the country's third largest public hospital will be out of cash and unable to pay its 12,000 employees.

If Jackson were a patient, its condition would be considered critical.

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Long before she was a county commissioner, Sally Heyman was a cop. And she said she had one simple rule.

"God forbid your shot, get you to Jackson," she said.

Heyman still feels that loyalty to Jackson.

In 2007, when Heyman needed a complicated surgery to deal with her chronic back pain she went to Jackson. A team of specialists removed three vertebrae from her lower back and replaced them with cadaver bones. The surgery lasted almost eight hours and she remained in the hospital for nearly three weeks.

"I'm two and a half years post surgery and I never received a bill," she claimed. "And I am fully insured and I am fully capable of paying my deductible and I never received a bill."

Citing privacy laws, Jackson officials would not comment on Heyman's allegations. But Heyman's story is not unique. People inside Jackson's own billing department tell the CBS4 I-Team that a day hardly goes by where the hospital isn't losing money because it either failed to get the proper approvals in advance from the insurance company or simply couldn't get a bill out in a timely manner.

"It starts with someone just taking the patients information to begin with and properly filing it, directing it, entering it or whatever else," she said. "There are flaws in the system and I don't think anyone is adequately or successfully addressing it. It is decades old, I can tell you that, I know firsthand."

Jackson even has forms and procedures in place to deal with bills that will have to be written off -- which is the hospital's term for money that will never be collected.

"This is symptomatic of Jackson's problems," Heyman said. "We have some of the best practitioners, we have incredible professionals who can give the best of care, but when we have people who have the ability to pay that are never billed. And then, for whatever reason, you have hundreds of millions of dollars waiting to be outdated and written off as uncollectable, it is irresponsible and unconscionable."

Jackson's problems go beyond collecting money it's owed for services. The downturn in the economy has meant the hospital has not received as much as it had expected from both its share of property taxes and from the half-cent dedicated to it from the county sales tax. With unemployment rising, Jackson is also seeing an increase in the number of people who are showing up at the hospital without insurance.

But with the hospital expected to lay off anywhere from 500 to 2,000 employees in the next two weeks while also closing vital services throughout the county, the hospital's billing and collection department is being scrutinized like never before.

Last year, the hospital wrote off $712 million in so-called bad debt. How much of that was due to easily avoidable mistake -- the hospital wouldn't say, even though theoretically they do have a way to track it.

"Every number has a story," said Jackson President and CEO, Dr. Eneida Roldan. "Again I don't want to say everything in this hospital is 100 percent perfect. This hospital has gone through a lot of conversions, a lot of changes, both structural, management, leadership etc."

Roldan, who has been Jackson's president for only seven months, has been touting a new billing system the hospital installed a year ago. Critics say a new software program will not address the fundamental problem. Sources both inside the billing department and those who regularly deal with it, say supervisors and managers are too quick to write off bills and bury their mistakes amid a mountain of debt.

And the new system Roldan has talked about may have caused the hospital to lose millions of dollars last year.

"When you switch to a new system, your focus becomes the new system in the conversion so some of that older receivable may have lost some focus on the collectability," said Chris Bayer, the vice president for budget and finance at Jackson.

Pressed as to why the hospital would "lose focus" on collecting money -- especially during a severe economic crisis -- Bayer couldn't explain it.

"Well absolutely people were continuing to focus on those receivables, some people were, but we had to divert some people to install the new system," he said. "Maybe I should let Carmen respond to this because I don't know how else to answer it other than I have."

Carmen is Carmen Pla, who oversees the hospital's billing and collection department and was sitting in on CBS4's interview with Bayer.

When we asked her about Bayer's comments, she said: "It was his answer and I can't really explain what he was trying to explain."

And therein lies another problem at Jackson: Getting accurate -- or even consistent --information about the hospital's deficit and its billing department. The hospital's new chief operating officer David Small recently declared that 46 percent of all state Medicaid claims were either denied or delayed because Jackson didn't properly fill out the forms.

We asked Bayer about that figure.

"I would like to turn that over to Carmen," Bayer said.

Pla's response: "I don't know the source of that comment."

Even Roldan, Jackson's president, said she doesn't know where Small came up with that figure or if it is even true.

During a recent meeting of Jackson's governing board, Roldan and her team informed the board that Jackson North and Jackson South were projected to lose $78 million this year.

Three hours later in an interview with the I-Team, she said the correct figure was actually $35 million.

Mistakes like that are causing members of Jackson's governing board, The Public Health Trust, as well as leaders at County Hall to question Roldan's grasp of the problem. No one blames Roldan or her team for causing the mess that Jackson is in. They have all been in place less than two years. But people are beginning to wonder if they are capable of correcting the problem.

"We need to clean up our house and it has got to be quickly," Heyman said. "Legitimate numbers instead of deficit du jour have got to be addressed and this clock that is ticking is a bomb. We cannot exist without Jackson."