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It seemed like a good plan: Hire three companies to collect money missed by the Cook County hospital system's problematic billing system. The companies each would do a share of the work, competing to be chosen for a bigger contract later.
But nearly all of the work in the 11 months ended in May went to one company, Chicago-based Great Lakes Medicaid.
The work was handed out to the contractors "inconsistently and based on personal relationships," said Tom Glaser, chief operating officer of the county health bureau, during a county meeting in June.
Glaser said he's fired the county staff responsible for the mess and put in a new system and new people.
County officials say they don't know who was responsible and they are not investigating.
The three companies have nearly identical contracts worth up to $1.8 million each to do what's called "patient eligibility" -- helping county hospital patients apply for programs such as Medicaid that will pay the county for services when the patient gets sick.
The companies are paid between 7 percent and 8 percent of the amount they each help the county collect.
"The thought was originally we would put them on an equal footing to do the competition and then go with one or two of those," Glaser said.
Great Lakes co-owner Dennis Kibby declined to comment, saying his agreement with the county forbids him from talking about it.
While Glaser has taken steps to correct the problems, the county has refused to release records that might shed light on what each company did and how the work was handed out.
In early June, the Daily Southtown asked the county for copies of the monthly activity reports filed by each company.
After promising to release the records for nearly a month, county health officials denied the request last week, saying it was too much work.
In March, the county admitted finding more than $130 million in unpaid bills stuffed in boxes. They were supposed to be sent to contractors such as Great Lakes and its competitors.
Of that $130 million, county officials said they'd be lucky to get $30 million back since most of the bills are too old to qualify for federal compensation.
"The fact that the county did not get all revenues in the past, in general, has hurt the county," acknowledged Andre Grant, spokesman for county board President Todd Stroger. "How much this particular situation hurt the county is uncertain."
Grant said county officials do not have hard evidence about what happened or who was responsible for the way patient accounts were farmed out to contractors.
"We just don't know. This happened prior to this administration being in charge," Grant said. "We're not sure that it's anything criminal; we don't have any evidence to this point to push forward with any kind of investigation."
Under the old system, competitors said, politics controlled who got the work.
"It's political; most decisions in Cook County are political," said Lisa Riding, executive vice president at Dallas-based Eligibility Services Inc.. "We're trying to appeal some of the decisions that have been made."
An official from another competing company, who asked not to be named, said his company repeatedly was stonewalled as it tried to get started on county accounts. County officials refused to give space to work and took months to return documents.
Great Lakes Medicaid got $714,158 worth of work between July 1, 2006, when all of the companies signed new contracts, and the end of May, records show.
HRM Consultants received $43,202 worth of work. And ESI, another longtime county contractor, billed the county for nothing during that period.
A fourth company, Chamberlin Edmonds, which was supposed to qualify patients for Social Security disability payments as well as Medicaid eligibility under a slightly different contract, also was paid nothing.
Great Lakes and its owners, attorneys Kibby and James Knepper, have donated $21,900 to Cook County politicians since 2000.
The company also apparently was a favorite of former Stroger Hospital chief Lacy Thomas. He got the company hired in Las Vegas after he became head of that city's public hospital system in 2003.
Thomas' dealings, including his decision to hand Great Lakes a no-bid contract for the Las Vegas hospital system, are the subject of a criminal probe. Clark County, Nev., commissioners fired Great Lakes and two other Chicago-based contractors shortly after they fired Thomas earlier this year.
Neither Thomas nor Great Lakes has been charged with any wrongdoing, and both have said they did nothing wrong.
Kibby said hospital officials never complained about his company's performance until they canceled the contract.
The company still works on patient accounts it started, he said.
"If they thought we had committed fraud, they wouldn't let us keep the patient accounts," Kibby said.