YELLOW SHEET Office of the State Auditor of Missouri |
August 26, 2003
Report No. 2003-88
The
following problems were discovered as a result of an audit conducted by our
office of the Department of Mental Health,
From
July 1999 to March 2001, the Higginsville Habilitation Center (HHC) paid
employees over $130,000 related to three bonus/incentive programs which were
established to address shortages in direct support staff.� The HHC did not review the legality of these
bonuses/incentives before implementing these programs.
Two
of the programs were implemented in July 1999, with one involving the payment
of a $200 "finders fee" to any staff who recruited a new employee for
the direct support workforce.� The other
program involved the payment of a $200 "sign on bonus" to any new
employee who became a permanent employee after successfully completing their
probation period.� The "finder's
fee" program was discontinued in January 2000, but the "sign on
bonus" program was revised to pay a $500 bonus to new employees hired
after that date.� From July 1999 through
March 2001, the facility expended $1,600 and $18,700 on "finder's
fees" and "sign on bonuses", respectively.
The
third program, effective
Between
Northwest
Community Services is an organizational unit of the HHC and it oversees the
operations of 25 separate individualized supported living homes (ISLs) located
in an adjoining three-county area.� The
ISLs have been established as either one-bed, two-bed, or three-bed homes.�
For
the year ended June 30, 2002, the average per client cost incurred by the state
for clients living in the three-bed homes totaled $72,956.� This compares to an average per client cost
in the two-bed homes and one-bed home of $94,286 and $134,847,
respectively.� Each home requires the
same basic round-the-clock staffing.�
Therefore, the more clients living at a home, the less the average costs
that are required to care for them.�
Standard criteria and procedures have not been established to document
and justify why clients might need to be placed in a more expensive placement
setting.
Although
the state receives reimbursement for a portion of the direct care personal
service costs incurred in the homes, the costs borne by the state related to
these homes are substantial.� During the
year ended June 30, 2002, the total cost of HHC's state-operated homes totaled
$4.9 million.� Of this amount, $2.5
million was reimbursed by the Medicaid waiver program, leaving about $2.4
million or approximately $38,000 per client to be paid for by the state.
A
comparison of the monthly census reports of clients on campus to the reports of
days billed to Medicaid disclosed that HHC billed Medicaid for days of service
in which Medicaid-eligible clients were in uncertified beds, resulting in
overbillings to Medicaid.� During a
review of the monthly census reports, we identified instances in which the
number of Medicaid-eligible clients in a unit exceeded the number of certified
beds.� We determined these situations
generally occurred when the facility was over capacity and temporary beds
needed to be set up to house the extra clients.�
It appears the reimbursement officer who handles the Medicaid billings
was not consistently notified when a Medicaid-eligible client was placed in an
uncertified bed.� The overbillings
identified totaled $276,203, resulting in excess net revenues of $168,513
(based on a Medicaid reimbursement rate of 60 percent).� Although HHC officials believe the
overbilling amount cited in the audit was overstated due to inaccuracies in the
monthly census reports, they could not identify any specific errors in the
reports.
The
two employees who work in the canteen were paid from the state's General
Revenue Fund, and the salary and benefit costs of these employees during the
two years ended June 30, 2002, totaled approximately $100,000.� During this period, no reimbursements were
made to the General Revenue Fund-State to offset these costs.� As a result, the General Revenue Fund-State
was substantially subsidizing the canteen operation.� This condition has also been reported in
previous audits.