YELLOW SHEET

Office of the State Auditor of Missouri
Claire McCaskill

Report No. 2000-112
October 25, 2000

The Department of Mental Health built the wrong size rooms in the new Southwest Missouri Psychiatric Rehabilitation Center, leaving the facility unable to seek Medicaid reimbursement for some clients. The department also paid an extra approximately $137,000 to construct the new center. 

We noted these concerns in our audit of the rehabilitation center. Our findings focused on eight areas:the new center in El Dorado Springs, expenditures, supported Community Placement Programs, fixed assets, vehicle usage, receipt controls, and employee meals.The following highlights our findings. 

New facility cost more, missed out on Medicaid reimbursement 

Inadequate planning of the new rehabilitation center in El Dorado Springs resulted in additional construction costs of $101,000 and additional rental costs of $36,222.In addition, the rooms built at the new facility do not meet the size requirements of the Medicaid reimbursement program, thus clients staying in the new center that could have qualified for such funds cannot.We could not determine how much the state lost in reimbursement revenue. (See page 7) 

Center paid another hospital�s costs 

The Department of Mental Health directed the rehabilitation center to pay more than $161,000 of Fulton State Hospital�s operating costs, but represented these costs as rehabilitation center expenditures.This practice overstates the center�s total costs and circumvents the state budget process. (See page 8) 

The facility also bought more than $25,000 in furniture, televisions, stereos and video recorders for the proposed expansion of the new center in June 1999, even though the state did not approve the project until October 1999.The items remain idle in storage and several were stolen in January 2000. Buying items before they are needed is an unnecessary use of state funds. (See page 8) 

Community Placement Program mixed client and operating funds 

Our audit reviewed six Community Placement Programs, which provide residential care for several rehabilitation center clients, and found these concerns: (See Page 10) 

        Some placement facilities maintained the client personal funds in the facility�s operating account, increasing the likelihood that client monies are not accounted for properly. 

        Some facilities did not keep invoices or vouchers to show disbursements of client funds oracquire appropriate approval for client purchases in excess of $100. 

        Some facilities allowed clients to keep a negative balance, which forced other clients to cover their expenses. 

Some staff primarily use state cars for commuting to work 

Two of the center�s top staff members use state cars mainly to drive to work.Between these two employees, their commutes total 150 miles daily.Mileage records showed that these commutes accounted for 63 percent of Executive Director�s total miles in his state car and 90 percent of the Unit Manager�s total miles. (See Page 13) 

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