NUMC is $1.4 billion in debt, nearly out of cash and one of New York's most vulnerable hospitals

Over a 45-year career with the East Meadow Fire Department, John Priest has brought hundreds, if not thousands, of patients to Nassau University Medical Center’s emergency room.

Thirteen years ago, emergency workers with that same fire department rushed Priest’s son to the facility after a heroin overdose.

"We spent a couple of days up there in the intensive care unit with some of the nicest people, knowing it wasn't going to turn out well," Priest said. To this day, he stays in touch with the doctor who cared for his son in his final days, he said. 

"That building is always going to hold special meaning for us," said Priest, who called the hospital "an institution." 

Recently, though, Priest has been worried about that institution's future on Long Island.

The facility has found itself on an increasingly shaky financial footing. Last year, the hospital’s parent company reported that it was facing debts totaling $1.4 billion. Its cash on hand is not even enough to fund two weeks of operations. And it has endured significant leadership turnover, after Albany Democrats enacted legislation this spring to wrest control of the hospital's board from Nassau Republicans.

Now, a Newsday analysis of financial records and federal data shows that Nassau University Medical Center’s budget woes date back at least a quarter century, making the facility one of New York’s most financially fragile hospitals.

Nassau University Medical Center’s parent company has consistently failed to break even for 24 out of the last 25 years — effectively, since the company was first created, Newsday found.

Those repeated losses have exacerbated a debt that, as of 2022, was the largest out of nearly 150 comparable hospitals in New York State, federal data shows. Those dire financial straits raise concerns about the hospital’s ability to fund its operations and provide quality care to its patients.

This is the first in a series of stories that will examine the hospital's finances and operations, diagnose the root causes of its dysfunction, and outline potential solutions to what has become one of Nassau County’s most intractable dilemmas: Nassau University Medical Center is "one of the biggest existential problems for the county," former County Executive Laura Curran said in an interview.

‘Not improving’

The hospital exists amid a mishmash of organizations and acronyms. For roughly the past quarter-century, Nassau University Medical Center has been governed by a public benefit corporation, the Nassau Health Care Corp..

Nassau Health Care Corp. also operates the A. Holly Patterson nursing home, a 589-bed facility in Uniondale, and is affiliated with Harmony Healthcare, a network of primary care clinics across the county. The corporation also provides medical care for residents of the Nassau County jail.

For years, the board that governed the corporation was largely appointed locally. The Nassau County executive and  legislature were able to name, or recommend, a majority of board members, and the county executive had the power to name the chair.

That changed earlier this year when Gov. Kathy Hochul signed legislation that shifted control of the board to largely Democratic state lawmakers and the governor, who now appoints the chair.

"NUMC’s financial issues have been longstanding, were not improving, and the mounting losses had become unsustainable," Cadence Acquaviva, a spokesperson for the New York Department of Health, said in an emailed response to a question about the reasons for the overhaul.

The hospital’s financial woes have long led to fears that the facility could close, and this year, Nassau County Executive Bruce Blakeman and allies have accused the state of actively seeking to shut the facility. Blakeman could not be reached for comment. 

Even before the state's overhaul of the board was official, the state vowed not to close the institution. State officials have called Nassau Republicans' claims inaccurate, saying they were part of an unsuccessful bid to stop the takeover. Still, if the facility is one day shuttered, the county, and potentially taxpayers, could be on the hook for millions of dollars of its debts.

What’s more, the medical center plays a key role in the county’s health care system. The 530-bed safety net hospital operates a Level 1 Trauma Center, meaning it is open 24/7 and able to treat patients with the most severe injuries. It also offers various specialty services, such as orthopedics, plastic surgery and a burn center, and it accepts all patients, regardless of their insurance status. Roughly 80% of its patients are on Medicaid or Medicare.

"I don't understand where the powers that be — whoever that might be — think that people like this are going to get this type of care if Nassau University Medical Center ceases to exist," said Priest, who chairs the East Meadow board of fire commissioners.

Decades of losses

Newsday analyzed operating budgets and financial statements from the Nassau Health Care Corp. from 2000 through 2024, as well as figures from the Nassau Interim Finance Authority, a state-established body with oversight over the county’s finances.

According to those records, the Nassau Health Care Corp. lost money every single one of those years except for 2009.

That year, the corporation reported a net income of $8.2 million. Every other year, the corporation lost amounts ranging from about $10 million to more than $145 million.

As of Oct. 27, the hospital’s parent company had $18.3 million in cash on hand, enough for about 10 days of operations, according to the Nassau Interim Finance Authority. The credit rating agency S&P categorizes hospitals with fewer than 80 days' cash on hand as "highly vulnerable," although its analysis focused on nonprofit hospitals.

"You can't run an institution where every other week you got to do a payroll and you're not sure if you're going to make it or not," Richard Kessel, the NIFA chair, said in an interview.

Those losses have hindered the hospital’s ability to pay for key benefits for its 3,400 employees.

As a public benefit corporation, Nassau Health Care Corp. staff participate in the state’s health insurance and retirement plans. But the corporation is behind on its payments to those programs.

A significant chunk of the institution’s debts come from unpaid premiums to the New York State Health Insurance Program, the health insurance plan that covers public employees. As of the end of July, the hospital’s parent company owed nearly $450 million in unpaid premiums, according to an August report from the Finance Authority.

Under a 2019 agreement with the state, the Nassau Health Care Corp. is paying $2 million a month toward its unpaid premiums. But the outstanding balance is growing by roughly $7 million a month, outstripping hospital leaders’ efforts to pay it down, according to the Authority.

As of Oct. 1, the corporation also owes about $22 million in unpaid contributions to New York’s public employee retirement system, according to a payment plan with the New York State comptroller obtained by Newsday through a public records request.

Under that plan, the institution has been paying down that debt with steadily increasing sums each month of 2025. A final payment of about $13 million is due in January.

The financial issues have not gone unnoticed by auditors. The corporation "is dependent on the continuation of federal, state and local subsidies, certain of which have or are scheduled to end or be reduced," auditors wrote in audited financial data released this year. "These matters raise doubt about NHCC’s ability to continue as a going concern."

Auditors have repeated those doubts for multiple years.

The Nassau Health Care Corp. has also been chronically late in submitting mandated financial data to the state Authorities Budget Office, which collects data on spending by public benefit corporations.

In 2017, the state office warned hospital leaders of a public "letter of censure" if the late records were not produced — after which the corporation quickly filed its documents.

Since then, however, the Nassau Health Care Corp. has fallen behind again. Joshua Norkin, director of the Authorities Budget Office, told Newsday in an email that the corporation currently has 12 overdue reports, from the years 2019 through 2024.

But, he said in an email, "No additional enforcement actions have been taken."

A spokesperson for the Nassau Health Care Corp. said that all the overdue reports should be filed by the end of the year. 

A dubious distinction

To an extent, Nassau University Medical Center’s losses are indicative of the plight of public hospitals around New York State.

Such hospitals often operate in the red while being kept afloat with taxpayer funds, according to Thad Calabrese, a professor of public and nonprofit financial management at New York University.

"Some of these public hospitals are too important to fail, in the sense that they may be the only providers for certain parts of the community, certainly for the uninsured," Calabrese said in an interview.

"So you just sort of go along with this subsidization long term of the operating loss," he said. "I'm not saying it's ideal. It sort of seems to be the system we’ve landed on in New York."

Still, Nassau University Medical Center is one of the most financially challenged hospitals in the state, even among its public peers. To compare the hospital with others in the state, Newsday analyzed financial data collected by the federal Center for Medicare & Medicaid Services for 144 hospitals in New York State from 2022, the most recent year available.

 That year, Nassau University Medical Center had more liabilities — it was roughly $1.2 billion in the red — than any other hospital in the data set.
 

That ratio of liabilities to assets is "very unhealthy," according to Ge Bai, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health. "Very concerning."

Aging facilities

From Nassau University Medical Center’s top floor, all seems well. The 19th floor, which hosts the hospital’s executive offices, boasts sleek conference rooms, modern furniture and an expansive view of the surrounding landscape.

But in a recent interview there, Richard Becker, a Northwell executive tapped by the newly appointed board to be Nassau Health Care Corp.’s interim CEO, readily admitted that the building was in worse shape than it appeared from its highest floor.

Becker, who is on leave from his role at Northwell while in the temporary CEO role, said that despite periodic renovations, the hospital has "substantial capital needs" — needs that include maintenance, upgrading aging equipment and modernizing software used for medical records and payment processing.

The building has "a couple of floors that are largely not utilized," Becker said.

Just months ago, the hospital’s chillers, machines that regulate the building’s indoor temperature, broke, requiring an expenditure of roughly $250,000 for temporary replacements, according to Becker and board meeting minutes. The hospital recently announced it had accepted a $1 million donation to replace 15-year-old equipment for mammography and bone density scanning.

The corporation also signed a $5 million contract in 2018 for work that included asbestos and lead abatement. According to meeting minutes, the former vice president of facilities, Kevin Mannle, told the board of trustees that asbestos needed to be removed "whenever there are repairs or renovations."

Becker, the interim CEO, said the new leaders are engaged in a sort of deep clean of the facility’s operations and finances, with the goal of stabilizing it.

"It's all taxpayer money," Becker said. "And so we want to make sure that the county is getting value for that, and that we can operate the hospital efficiently and effectively."

A state takeover

Nassau University Medical Center’s struggles came to a head earlier this year amid a series of controversies.

This spring, Gov. Kathy Hochul signed legislation overhauling the makeup of the hospital’s board, shifting control from Nassau County Republicans to the governor and Democrats.

Under the new system, the governor has the power to appoint six of 11 seats and name the chair. Hochul named Stuart Rabinowitz, the former president of Hofstra University, as well as five others to sit on the board.

The move drew swift backlash from Nassau GOP officials. In June, Blakeman, the county executive, decried it as an "illegal takeover" and vowed to file a lawsuit.

Newsday reached out multiple times via phone or email to a spokesperson for Blakeman to request an interview or comment. The spokesperson acknowledged one such request but did not ultimately make the county executive available for an interview or provide a comment.

The new body moved quickly to shake up the hospital’s governance. In mid-June, the board fired CEO Megan Ryan and tapped Becker to be the interim CEO.

A month later, Newsday reported that Ryan and other executives used Nassau Health Care Corp. funds to reimburse thousands of dollars in travel, lodging, and meals — including a lobster dinner at a high-end Manhattan restaurant.

The corporation is now suing Ryan, alleging that she and other executives took $1 million in improper payouts upon their departures before the new administration took power. Ryan is, in turn, suing the hospital and administrators for alleged defamation, breach of contract and retaliation, among other counts. Newsday contacted a spokesperson for Ryan to request an interview or comment, but the spokesperson declined to comment or make her available for an interview.

Amid the turmoil, the hospital’s new leaders say they see a path forward for the safety-net institution — albeit one that does not lead to fat profits.

"Nobody thinks we're going to, you know, fill our coffers with surpluses," Rabinowitz, the recently appointed board chair, said at a Sept. 30 meeting of the hospital’s board of trustees. Yet with the right reforms, Rabinowitz believes the hospital can ultimately achieve "a loss that's manageable," he said.

"Not $250 million a year, but $10 million a year," he said.