Audit report, schedule of home office allowable costs, Atlantic Homecare, Inc., Waycross, Georgia, for the year ended October 31, 1994, Georgia Department of Medical Assistance. [Oct. 31, 1994]

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STATE OF GEORGIA DEPARTMENT OF AUDITS
254 WASHINGTON STREET ATLANTA. GEORGIA 30334

AUDIT REPORT SCHEDULE OF HOME OFFICE ALLOWABLE COSTS
ATLANTIC HOMECARE, INC. WAYCROSS, GEORGIA
FOR THE YEAR ENDED OCTOBER 31, 1994 GEORGIA DEPARTMENT OF MEDICAL ASSISTANCE
Report Prepared By: State a/Georgia
Department ofAudits and Accounts Medicaid and Local Govemment Audits Division
254 Washli1gton Street, S.W., Suite 322 Atlanta, Georg;a 30334-8400 (404) 656-2006 Michael A. Plant, Director

ATLANTIC HOMECARE, INC. -TABLE OF CONTENTS -

AUDITOR'S REPORT

V

SCOPE OF THE AUDIT

SCHEDULE OF HOME OFFICE ALLOWABLE COSTS

NOTE TO SCHEDULE

SUMMARY OF FIELD AUDIT ADJUSTMENTS

EXPLANATION OF FIELD AUDIT ADJUSTMENTS

II

SUMMARY OF ALLOCATION TO CHAIN COMPONENTS

15

CLAUDE L VICKERS
STATE AUDITOR

DEPARTMENT OF AUDITS
254 Washington Street, S.W., Suite 214 Atlanta, Georgia 30334-8400
Telephone (404) 656-2006 Facsimile (404) 656-7535
June 14, I 995

Home Health Services Program Division of Non-Institutional Reimbursement Georgia Department ofMedical Assistance 2 Peachtree Street, NW 25th Floor Atlanta, Georgia 30303-3159
Ladies and Gentlemen:
We have audited the Home Office Cost Data Form filed with the Georgia Department of Medical Assistance under the Title XIX Medicaid Program by Atlantic Homecare, Inc., for the year ended October 31, 1994, and have compiled the accompanying Schedule of Home Office Allowable Costs based on our audit. The Home Office Cost Data Form is the responsibility of the management of Atlantic Homecare, Inc. Our responsibility is to determine if the home office allowable costs reported on the Home Office Cost Data Form are reasonable and allowable, in all material respects, in accordance with the federal and state laws, regulations, policies and procedures governing the Georgia Home Health Services Program. It is also our responsibility to report the results of our audit, including any required adjustments to the Home Office Cost Data Form, to the Georgia Department of Medical Assistance.
We conducted our audit in accordance with the Home Health Agency Home Office Audit Program approved by the Georgia Department ofMedical Assistance. Our audit included examining and evaluating, on a test basis, evidence supporting the amounts and disclosures on the Home Office Cost Data Form. Our audit also included assessing the accounting principles used and significant estimates made by management. We believe our audit provides a reasonable basis for our report.
As described in Note I ofthe Notes to Schedule, the accompanying Schedule of Home Office Allowable Costs was prepared to present the data necessary for the Georgia Department of Medical
V

Assistance to determine Medicaid reimbursement for the home health agency components of the home office and is not intended to be a presentation in accordance with generally accepted accounting principles, nor is it intended to be a complete presentation of the assets, liabilities, revenues and expenses of Atlantic Homecare, Inc., on the basis described.
In our opinion, the "adjusted totals" column in the accompanying Schedule of Home Office Allowable Costs - which was compiled by us and reflects any adjustments to home office allowable costs required as a result of our audit - presents fairly, in all material respects, the home office allowable costs of Atlantic Homecare, Inc., for the year ended October 31, 1994, on the basis of accounting described in Note 1.
This report is intended to be used solely in connection with the administration of the Georgia Department of Medical Assistance Home Health Services Program and is not to be used or relied upon for any other purpose.

CLV/scp/by

Claude L. Vickers State Auditor

vi

ATLANTIC HOMECARE, INC. SCOPE OF THE AUDIT
FOR THE YEAR ENDED OCTOBER 31, 1994
This audit was performed in order to determine if the home office allowable costs reported on the Home Office Cost Data Form are reasonable and allowable, in all material respects, in accordance with the federal and state laws, regulations, policies and procedures governing the Georgia Medicaid Program, and to report to the Georgia Department of Medical Assistance (DMA} any adjustments to the Home Office Cost Data Form required as a result of our audit.
In order to accomplish these objectives, we examined, on a test basis, evidence supporting the amounts and disclosures on the Home Office Cost Data Form, and assessed the accounting principles used and significant estimates made by management. Tested transactions and accounts were evaluated for compliance with DMA Policies and Procedures for Home Health Services and for compliance with federal laws and regulations applicable to the Title XIX Medicaid Program. Any adjustments to the Home Office Cost Data Form required as a result of our audit are included in this report on the Summary of Allocations to Chain Components.
Costs reported on the Home Office Cost Data Form are derived from data reported in the Medicare Home Office Cost Report (Form HCFA 287). Schedule B of the Medicare cost report summarizes the allowable costs claimed by the home office. The Schedule of Home Office Allowable Costs presented in this audit report is based on Schedule B ofthe Medicare Home Office Cost Report and shows the adjustments made to the individual expense categories as a result of our audit.
Our audit included a limited consideration of the organization's internal control structure sufficient to plan the audit. Our consideration for this limited purpose would not necessarily disclose all reportable conditions in the internal control structure. Accordingly, we do not express an opinion on the internal control structure.

ATLANTIC HOMECARE, INC. SCHEDULE OF HOME OFFICE ALLOWABLE COSTS
FOR THE YEAR ENDED OCTOBER 31, 1994

ALLOWABLE COSTS

PER MEDICARE COST REPORT AS FILED

FIELD AUDIT ADJUSTMENTS

ADJUSTED TOTALS

DIRECTLY ALLOCATED COSTS

Old Capital-Related Costs

Building and Fixtures

$

Non-Capital Related Costs

Legal Fees

Utilities

Security

Grounds

Water

Janitorial Expense

Communications

Repairs and Maintenance

Dues and Subscriptions

Taxes and Licenses - NonCapital Related

Dues National

Office Supplies

Miscellaneous

20,331 $
0 5,671 12,793
787 528 3,325 13,600 2,139
0
3,111 0 0 0

614 $ 2,131
(2,279) 23 137
1,062 366

20,945
2,131 5,671 12,793
787 528 3,325 11,321 2,139 23
3,111 137
1,062 366

Total Directly Allocated

Costs

$

62 285 $

FUNCTIONALLY ALLOCATED COSTS

Non-Capital Related Costs

Director ofProfessional

Services Salaries

$

34,751

FICA Taxes

1,866

Health Insurance,

Malpractice Insurance, Paid Days Off

5,355

Pension Expense

3,484

2 054 =$===6==4=3=39=

$

34,751

1,866

5,355 3,484

2

ATLANTIC HOMECARE, INC. SCHEDULE OF HOME OFFICE ALLOWABLE COSTS
FOR THE YEAR ENDED OCTOBER 31, 1994

ALLOWABLE COSTS

PER MEDICARE COST REPORT AS FILED

FIELD AUDIT ADJUSTMENTS

ADJUSTED TOTALS

FUNCTIONALLY ALLOCATED COSTS (continued)

Director ofProfessional

Services

Automobile Expenses

$

3,197

Transportation, Education

Expense

1,523

Assistant Director of

Professional Services -

Salaries

43,446

Health Insurance,

Malpractice Insurance,

Paid Days Off

8,160

Pension Expense

4,355

Automobile Expense

3,990

Travel, Education,

Seminar

411

FICA Tax

3,778

Chief Financial Officer -

Salaries

54,035

FICA Tax

3,517

Health Insurance, Paid

Days Off

12,352

Automobile Lease, Gas,

Oil, Insurance

5,103

Education, Meals,

Lodging,

Transportation, Fees

3,073

Pension Expense

5,417

$

3,197

1,523

43,446

8,160 4,355 3,990
411 3,778
54,035 3,517
12,352
5,103

3,073 5,417

Total Functionally Allocated Costs

$

197 813

$

197 813

3

ATLANTIC HOMECARE, INC. SCHEDULE OF HOME OFFICE ALLOWABLE COSTS
FOR THE YEAR ENDED OCTOBER 31, 1994

ALLOWABLE COSTS

PER MEDICARE COST REPORT AS FILED

FIELD AUDIT ADnJSTMENTS

ADnJSTED TOTALS

POOLED COSTS

Old Capital-Related Costs

Building and Fixtures

$

Movable Equipment

Non-Capital Related Costs

Salaries of Officers

Director ofProfessional

Services Salaries

FICA Taxes

Health Insurance,

Malpractice Insurance,

Paid Days Off

Pension Expense

Automobile Expenses

Transportation, Education

Expense

Assistant Director of

Professional Services -

Salaries

Health Insurance,

Malpractice Insurance,

Paid Days Off

Pension Expense

Automobile Expense

Travel, Education,

Seminar

FICA Tax

Salaries and Wages of

Others

16,134 $ 50,004
103,738
65,013 3,492
10,018 6,518 5,722 3,110
31,530
5,887 3,161 2,896
334 2,742 105,188

(!, 113) $ (323)

15,021 49,681
103,738

65,013 3,492

10,018 6,518 5,722
3,110

31,530

5,887 3,161 2,896
334 2,742
105,188

4

ATLANTIC HOMECARE, INC. SCHEDULE OF HOME OFFICE ALLOWABLE COSTS
FOR THE YEAR ENDED OCTOBER 31, 1994

ALLOWABLE COSTS

PER :MEDICARE COST REPORT AS FILED

FIELD AUDIT ADJUST:MENTS

ADJUSTED TOTALS

Chief Executive Officer -

Automobile Lease, Gas,

Oil

$

Education Travel,

Lodging, Entry Fees

Mileage - Secretary, Data

Processing

Secretary - Education Meals

Physicals - Secretary,

Accounting Clerk

Data Processing -

Contracted Services

Clerical - Contracted

Services

Payroll Taxes

Employee Benefits Payroll Related

Non-Payroll Related

Profit Sharing/Pension Plans

ChiefFinancial Officer -

Salaries

FICA Tax

Health Insurance, Paid

Days Off

Automobile Lease, Gas, Oil, Insurance

Education, meals,

Lodging,

Transportation, Fees

Pension Expense

Legal Fees

9,252
5,531
770 86
181
6,592
439 919
39,100 18,904 20,945
22,995 1,497
5,257
2,172
1,307 2,305 34,279 $

$

9,252

5,531

770 86

181

6,592

439 919

39,100 18,904 20,945

22,995 1,497

5,257

2,172

(8,496)

1,307 2,305 25,783

5

ATLANTIC HOMECARE, INC. SCHEDULE OF HOME OFFICE ALLOWABLE COSTS
FOR THE YEAR ENDED OCTOBER 31, 1994

ALLOWABLE COSTS

PER :MEDICARE COST REPORT AS FILED

FIELD AUDIT ADJUST:MENTS

ADJUSTED TOTALS

POOLED COSTS (continued)

Auditing and Accounting

Fees

$

Utilities

Security

Grounds

Water

Janitorial Expense

Communications

Cleaning, Office, and

Administrative Supplies

Repairs and Maintenance

Dues and Subscriptions

Insurance Premiums -

Non-Capital Related

Contents

Taxes and Licenses - NonCapital

Board Meetings

Data Processing Expense

Dues - State and Local

Dues - National

Printing

Office Supplies

Consulting Fees

Postage

Bank Charges

Coffee and Soft Drinks

Miscellaneous

10,700 6,685 18,115
789 474 4,539 22,980 $
189 3,029 12,233
352,533 19,842
4,481 93
41,411 7,910 5,990 451 10,245 11,654
17,708 173 181
1,428

$
(3,226) (1,115)
(7,825) (3,490) (1,062)
285

10,700 6,685 18,115
789 474 4,539 19,754
189 3,029 11,118
352,533 19,842
4,481 93
41,411 85
2,500 451
9,183 11,654 17,708
173 181 1,713

Total Pooled Costs

$ 1 141 851 $

(26 365) =$=====1=1=15==48=6==

6

ATLANTIC HOMECARE, INC. NOTES TO SCHEDULE
FOR THE YEAR ENDED OCTOBER 31, 1994
NOTE I: SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES ENTITY INFORMATION
Atlantic Homecare, Inc., filed a Home Office Cost Data Form with the Georgia Department ofMedical Assistance for the year ended October 31, 1994. The Medicare Home Office Cost Report listed six chain components, five of which are home health agencies, three of which are in Georgia. In addition to the audit ofthe Home Office Cost Data Form, audits have been made of provider cost data forms filed by three components of the chain organization:
Atkinson Visiting Nurses Service Charlton Visiting Nurses Service Ware Visiting Nurses Service, Inc.
BASIS OF ACCOUNTING The Home Office Cost Data Form and the associated Schedule of Home Office Allowable
Costs, hereinafter referred to as the Schedule, were prepared in conformity with the Principles of Reimbursement for Provider Cost published by the Secretary of Health and Human Services as modified by the provisions of Policies and Procedures for Home Health Services published by the Georgia Department of Medical Assistance. This basis of accounting required by the Medicaid Program differs from generally accepted accounting principles. Consequently, the information presented in this report reflects only the home office allowable costs required for DMA to determine the Medicaid reimbursement rate for the home health agency components of the home office. This report does not reflect the home office's financial position or the results of its operations; it is intended to be used solely in connection with the administration of the Georgia Department of Medical Assistance Home Health Services Program and is not to be used or relied upon for any other purpose.
NOTE 2: FIELD AUDIT ADJUSTMENTS The Field Audit Adjustments column on the Schedule is provided to show the net effect of
adjustments made during the field audit process. The audit adjustments made as a result of this audit are shown on the Summary ofField Audit Adjustments and are explained in the Explanation of Field Audit Adjustments.
7

ATLANTIC HOMECARE, INC. SUMMARY OF FIELD AUDIT ADJUSTMENTS
FOR THE YEAR ENDED OCTOBER 31, 1994

ADJUSTMENT NUMBER

DIRECTLY ALLOCATED COSTS

BUILDING AND FIXTURES (OLD)

Costs Applicable to Specific Chain

Components

$

821

2

Assets Leased From Related Party

(207) $

LEGAL FEES

Costs Applicable to Specific Chain Components

CO:MMUNICATIONS

3

Costs Not Related to Patient Care $

(2,671)

4

Home Office Costs Paid by Chain

Component

392

DUES AND SUBSCRIPTIONS

Costs Applicable to Specific Chain Components

DUES - NATIONAL

Costs Applicable to Specific Chain

Components

$

275

3

Costs Not Related to Patient Care

(1382

OFFICE SUPPLIES

Costs Applicable to Specific Chain Components

614 2,131 (2,279)
23 137 1,062

8

ADWSTMENT NUMBER

ATLANTIC HOMECARE, INC. SUMMARY OF FIELD AUDIT ADJUSTMENTS
FOR THE YEAR ENDED OCTOBER 31, 1994
DIRECTLY ALLOCATED COSTS (continued)

MISCELLANEOUS

Costs Applicable to Specific Chain

Components

366

Net Adjustment to Directly Allocated Costs

$

2054

POOLED COSTS

BUILDING AND FIXTURES (OLD)

Costs Applicable to Specific Chain

Components

$

(821)

2

Assets Leased From Related Party

(292) $

(1,113)

MOVABLE EQUIPMENT (OLD)

5

Excess Depreciation

(323)

LEGAL FEES

Costs Applicable to Specific Chain

Components

$

(2,131)

3

Costs Not Related to Patient Care

(6,365)

(8,496)

COMMUNICATIONS

3

Costs Not Related to Patient Care $

(3,782)

4

Home Office Costs Paid by Chain

Component

556

(3,226)

9

ADJUSTMENT NUMBER

ATLANTIC HOMECARE, INC. SUMMARY OF FIELD AUDIT ADJUSTMENTS
FOR THE YEAR ENDED OCTOBER 31, 1994
POOLED COSTS (continued)

DUES AND SUBSCRIPTIONS

Cots Applicable to Specific Chain

Components

$

(23)

3

Costs Not Related to Patient Care

(1,092)

DUES - STATE AND LOCAL

3

Costs Not Related to Patient Care

DUES - NATIONAL

Costs Applicable to Specific Chain

Components

$

(275)

3

Costs Not Related to Patient Care

(3,215)

OFFICE SUPPLIES

Costs Applicable to Specific Chain Components

MISCELLANEOUS

Costs Applicable to Specific Chain

Components

$

(366)

3

Costs Not Related to Patient Care

(325)

4

Home Office Costs Paid by Chain

Component

976

(1,115) (7,825) (3,490) (1,062)
285

Net Adjustment to Pooled Costs

$ (26 365)

10

ATLANTIC HOMECARE, INC. EXPLANATION OF FIELD AUDIT ADJUSTMENTS
FOR THE YEAR ENDED OCTOBER 31, 1994

ADWSTMENT NUMBER

EXPLANATION

COSTS APPLICABLE TO SPECIFIC CHAIN COMPONENTS

Allowable costs claimed by the home office included expenses applicable to specific chain components. Federal regulations provide that allowable costs incurred for the benefit of, or directly attributable to, a specific provider must be allocated directly to the chain entity for which they were incurred. This adjustment is made to reclassify the costs applicable to a specific chain component from pooled costs to directly allocated costs. (HCFA 15-2150.3B)

DIRECTLY ALLOCATED COSTS Building and Fixtures (Old) Legal Fees Dues and Subscriptions Dues - National Office Supplies Miscellaneous
POOLED COSTS Building and Fixtures (Old) Legal Fees Dues and Subscriptions Dues - National Office Supplies Miscellaneous

$

821

2,131

23

275

1,062

366

(821) (2,131)
(23) (275) (1,062) (366)

Total Adjustment to Allowable Costs

$

0

II

ADJUSTMENT
NUMBER

EXPLANATION (continued}

2

ASSETS LEASED FROM RELATED PARTY

Documentation examined during the audit showed that land, buildings, and/or equipment used in health care operations were leased from a related party. Federal regulations provide that reimbursement to a provider leasing facilities or equipment from a related organization is limited to the costs of ownership of the leased assets. This adjustment is made to decrease allowable expenses to the cost to the related party. (HCFA 15-1011.5)

DIRECTLY ALLOCATED COSTS Building and Fixtures (Old)
POOLED COSTS Building and Fixtures (Old)

$(207) (292)

Net Adjustment to Allowable Costs

$

(499)

3

COSTS NOT RELATED TO PATIENT CARE

Expenses claimed in the cost report included payments which were not considered to be for patient care operations. Federal regulations provide that costs which are not appropriate or necessary and proper in developing and maintaining the operation of patient care facilities and activities are not allowable in computing reimbursable costs. This adjustment is made to remove the non-patient care expenses from allowable costs. (HCFA 15-2102.3, 2136.2, 2139; DMA Policies and Procedures Section 1001.2 (a), (b), (f), (g), (h))

12

ADJUSTMENT NUMBER

EXPLANATION (continued)

Items Appeal Legal Services (Relief not granted) Association Dues (50%) Civic Organization Dues Charitable Contributions Directory Advertising Gifts Lobbying Expenses Marketing Expense

DIRECTLY ALLOCATED COSTS Communications Dues - National
POOLED COSTS Legal Fees Communications Dues and Subscriptions Dues - State and Local Dues - National Miscellaneous
Total Adjustment to Allowable Costs

$ (6,365) (2,638) (1,257) (985) (6,995) (325) (830) (6,018)
$ {25,413}

$

(2,671)

(138)

(6,365) (3,782) (1,092) (7,825) (3,215)
(325)

$ {25,413}

4

HOME OFFICE COSTS PAID BY CHAIN COMPONENT

Reimbursable costs claimed by a component of the chain organization included amounts incurred for the benefit of the entire chain. Federal regulations provide that allowable costs incurred for the benefit of, or directly attributable to, a specific provider must be allocated directly to the chain entity for which they were incurred; however, federal regulations also provide that allowable costs that have not been directly assigned to specific chain components must be allocated among the providers on a basis to equitably allocate the costs over the chain components or activities

13

ADJUSTMENT
NUMBER

EXPLANATION (continued}

receiving the benefits of the costs. This adjustment is made to increase allowable costs claimed for expenses paid by a chain component which benefited the entire chain. (HCFA 15-2150.3)

DIRECTLY ALLOCATED COSTS Communications

$

392

POOLED COSTS

Communications

556

Miscellaneous

976

Total Adjustment to Allowable Costs

$

1,924

5

EXCESS DEPRECIATION

Documentation examined during the audit in support of fixed assets and depreciation showed that either the property was not included in the proper class or depreciation was not calculated in accordance with AHA guidelines. Federal regulations provide for the use of minimum required asset lives. This adjustment is made to reduce allowable costs claimed by the amount of depreciation expense claimed in excess of total allowable. (HCFA 15-104.17)

POOLED COSTS Movable Equipment (Old)

$

(323)

14

ATLANTIC HOMECARE, INC. SUMMARY OF ALLOCATION TO CHAIN COMPONENTS
FOR THE YEAR ENDED OCTOBER 31, 1994

CHAIN COMPONENTS

ALLOCATION OF ADIDSTMENTS TO:

DIRECTLY ALLOCATED
COSTS

ALLOCATION
m STATISTICS

POOLED COSTS

GEORGIA HOME HEALTH AGENCIES

Atkinson Visiting Nurses

Service

$

Charlton Visiting Nurses Service

Ware Visiting Nurses Service, Inc.

TOTAL GEORGIA HOME

HEALTH AGENCIES

137
1,248 1,385

(3)

$

60

(176)

(I 19)

$

(5,773) (3,759) (7,020) (16,552)

TOTAL OTHER

COMPONENTS

669

119

(9,813)

TOTAL ALLOCATION

2,054

0

(26,365)

(1) Adjustments were made to the pooled cost allocation statistics shown on the as-filed Medicare Home Office Cost Report. The amounts in this column reflect the reallocation of the as-filed home office pooled costs.

15