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Conditions in the county hospital were deplorable, a culture of callousness pervasive and impoverished patients faced many barriers to care. Yet the system is rolling in money, primarily because it raised rates so that it could game federal Medicaid money that was supposed to help the poor. Rather than using it for that purpose, the taxpayer-financed system banked the money or invested it to try to attract insured patients, as highlighted by decisions to purchase a boutique hospital and a clinic in a high-income area. Officials of the healthcare system also misled the public, the hospital board and county officials about the finances and conditions in the hospitals and clinics.