Audit report, for the year ended June 30, 1998, Metter Nursing Home, Medicaid provider no. 00141963A, Nursing Facilities Services Program [June 30, 1998]

TABLE OF CONTENTS

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5

Summary of Audit Findings Affecting Allowable Costs and Patient Day Statistics 12

Schedule of Allowable Costs and Patient Day Statistics

14

Report Prepared By:
State ofGeorgia Department ofAudits and Accounts Medicaid and Local Government Audits Division 254 Washington Street, S. W:, Suite 322
Atlanta, Georgia 30334-8400 (404) 656-2006
Michael A. Plant, Director

RUSSELL W. HINTON
STAn: AUDITOR

DEPARTMENT OF AUDITS AND ACCOUNTS
MEDICAID AND LOCAL GOVERNMENT AUDITS
254 Washington Street, S.W., Suite 322 Atlanta, Georgia 30334-8400 Telephone (404) 6562006 Facsimile (404) 656-7535

MICHAEL A. PLANT
DIIlJ:CfOR

July 27, 1999

Members of the Board of Medical Assistance, and

The Honorable Dr. William R. Taylor, Commissioner

Department of Medical Assistance

.

2 Peachtree Street, N.W., 40th Floor

Atlanta, Georgia 30303

Ladies and Gentlemen:

This report provides the results of our audit of Metter Nursing Home, provider number 00141963A, a participant in the Nursing Facility Services Program for the year ended June 30, 1998. This report is intended to be used solely in connection with the administration of the Georgia Department of Medical Assistance Nursing Facility Services Program and is not to be used or relied upon for any other purpose.

Respectfully Submitted,
~W.41~ Russell W. Hinton State Auditor

RWHlbsf/teh

1998 Audit Report: Metter Nursing Home

1

INTRODUCTION

General Information

The Georgia Medical Assistance Program (Medicaid) is administered by the Georgia Department of Medical Assistance and is jointly funded by the State of Georgia and the federal government. Medicaid
o
pays health care providers for furnishing health care services to individuals or families with low income and limited resources. The Department of Medical Assistance has established specific payment guidelines and limitations for each covered medical service.

Through the Nursing Facility Services Program, Medicaid pays for care in institutional settings for recipients who are unable to remain at home or in the community. Nursing homes are paid for this service using rates calculated from Nursing Home Cost Reports submitted by each provider. These cost reports include financial, patient census, and other information. Information included in the Nursing Home Cost Report is subject to audit by the Department of Medical Assistance or its agents. In an agreement with the Department of Medical Assistance, the Department of Audits and Accounts has accepted the responsibility of auditing Medicaid providers.

Provider Information

Metter Nursing Home, an 89-bed long-term health care facility located in Metter, Georgia, is a provider enrolled in the Georgia Medicaid Nursing Facility Services Program. The facility provides both skilled and intermediate care services to resident patients.

2

Nursing Facility Services Program

The facility was owned by CCT Family Partnership and operated as a component ofTaylor and Bird, Inc., a chain organization which filed a Home Office Cost Report with DMA for the year ended June 30, 1998.

Audit Objectives

The purpose of this audit was to determine whether Metter Nursing Home maintained adequate documentation to support the allowable costs and patient day statistics reported in its Nursing Home Cost Report for the year ended June 30, 1998; and to determine whether Metter Nursing Home complied with the federal and state laws, regulations, policies and procedures for the Nursing Facility Services. Program in effect for that period. The specific objectives of this audit were to:



determine if allowable costs reported in the Nursing

Home Cost Report are reasonable and allowable, in

all material respects, in accordance with federal and

state laws, regulations, policies and procedures

governing the Georgia Nursing Facility Services

Program;



compare patient day statistics included in the cost

report to provider records to determine if the patient

day statistics are accurately reported; and

recommend appropriate action based on the results of our audit.

1998 Audit Report: Metter Nursing Home

3

Scope and Methodology

To accomplish these objectives, we perfonned a limited review of the provider's internal control structure to the extent necessary to plan our audit. We interviewed provider personnel and examined records and documentation to determine the adequacy of amounts and disclosures included in the Nursing Home Cost Report. We also reviewed, on a
"
test basis, evidence supporting these amounts and disclosures and assessed the accounting principles used and significant estimates made by management. We evaluated the tested transactions and accounts for compliance with cost reporting principles included in the Health Care Financing Administration Provider Reimbursement Manual (HCFA Pub. 15-1) and DMA Policies and Procedures for Nursing Facility Services.
In accordance with Section 1002 of Policies and Procedures for Nursing Facility Services, the Department of Medical Assistance has calculated the payment rate for Metter Nursing Home using a method often called the "Dodge Index System". Under the Dodge Index System, reasonable construction and asset acquisition costs are used in calculating the payment rate rather than the actual costs incurred by the nursing home for property costs such as depreciation and amortization; capital-related interest expense; and lease expense. Because these property costs are not considered by the Department of Medical Assistance when calculating the payment rate for Metter Nursing Home, our audit did not include a review of these costs. However, becallSe property taxes and insurance are used by the Department of Medical Assistance to calculate the provider's payment rate, we have reviewed those costs as part of our audit.

4

Nursing Facility Services Program

As a result of audit procedures related to other (non-property) costs, we noted adjustments which should be made by the Department of Medical Assistance rt;llated to depreciation and amortization and lease expense. We have included findings related to these matters in our report.
The Department of Audits and Accounts is responsible for providing the Department of Medical Assistance with infonnation regarding the accuracy of cost and patient data for Metter Nursing Home for the year ended June 30, 1998. If the Department of Medical Assistance implements the recommendations in this report by adjusting the allowable costs and/or patient day statistics used in calculating the provider's billing rate, the provider may appeal to the Department of Medical Assistance for reconsideration of the audit findings. For this reason, we have not included a response from the provider in our report. However, we have discussed the contents of this report with the provider and have considered its responses when preparing the report. In all other respects, this audit was conducted in accordance with generally accepted government auditing standards..

1998 Audit Report: Metter Nursing Home

5

FINDINGS AND RECOMMENDATIONS

Incorrect Expense Classifications

Finding No.1

Documentation examined during the audit showed that some of the expenses were not classified in accordance with the Uniform Chart of Accounts prescribed by the Department of Medical Assistance for providers participating in the Medicaid Nursing Facilities Services Program. We recommend that the provider implement policies and procedures to ensure that all of its expenses are classified in the appropriate cost centers. We recommend that the Department of Medical Assistance make the following adjustment to reclassify costs to the appropriate cost centers.
(DMA Policies and Procedures, Appendix D)

COST CENTER

Routine Services

Administrative Supplies

$

Dietary Supplements

Laundry Supplies

Medical Records Supplies

Special Services

Cable Television Expense

$

Provider Revenue Offset

Dietary

Dietary Supplements

$

Dietary Supplies

Raw Food

Laundry and Housekeeping

Laundry Supplies

Operation and Maintenance ofPlant

Maintenance Agreement

$

Provider Revenue Offset

Raw Food

Repairs and Maintenance

Administrative and General

Administrative Supplies

$

Business License Expense

Cable Television Expense

6

Nursing Facility Services Program

Dietary Supplies Lease Expense Maintenance Agreement Medical Records Supplies Repairs and Maintenance Property and Related Expenses Business License Expense Lease Expense
Total Adjustment to Allowable Costs

(33) (1,191)
(274) 234 (1,123)

$

(824)

1,191

(3,346) 367

$====0=

Finding No.2

Accrual Basis ofAccounting
Documentation examined during the audit showed that amounts recorded for certain expenses did not reflect actual amounts incurred for the period under review. Federal regulations provide that expenditures are recorded in the period in which they are incurred, regardless of when they are paid. We recommend that the provider implement policies and procedures to ensure that costs are recorded in the period in which they are incurred. We recommend that the Department of Medical Assistance make the following adjustment to increase allowable costs claimed for expenses applicable to the year under review.
(HCFAPub. 15-1 Section 2302.1)

Adjustments to Balance Sheet Accounts:
June 30, 1997 Balance Accounts Payable Accrued Payroll Taxes

Allowable Costs

$

(404)

1,063

$

659

1998 Audit Report: Metter Nursing Home

7

June 30, 1998 Balance Accrued Retirement Plan Contributions Property Taxes Payable
Total Adjustment to Allowable Costs
COST CENTER Routine Services Special Services Dietary Laundry and Housekeeping Operation and Maintenance of Plant Administrative and General Property and Related Expenses
Total Adjustment to Allowable Costs

$

1,452

(605)

$

847

$= = = =1,=50=6

$

1,766

97

220

189

(368)

207

(605)

$-======1..,5..=06=

Nurse Aide Testing and Training Costs

Finding No.3

Documentation examined during the audit showed that the provider did not remove nurse aide testing and training costs from allowable costs claimed as required by the Department of Medical Assistance in General Instructions to Cost Report: We recommend that the provider implement policies and procedures to ensure that nurse aide testing and training costs are not included in allowable costs. We recommend that the Department of Medical Assistance make the following adjustment to decrease allowable costs by the amount of nurse aide testing and training costs.
(DMA General Instructions to Cost Report)

8

Nursing Facility Services Program

COST CENTER Routine Services Administrative and General
Total Adjustment to Allowable Costs

$

(475)

(l00)

$======(5=75=)

Fixed Asset Purchases Claimed as Expense

Finding No.4

Allowable costs claimed included purchases of assets which are considered to be capital additions to property under generally accepted accounting principles. The Uniform Chart of Accounts issued by DMA provides for inclusion of such assets in property accounts. We recommend that the provider implement policies and procedures to ensure that all purchases of fixed assets are shown on the cost report as capital additions. We recommend that the Department of Medical Assistance make the following adjustment to reduce allowable costs by the amount of purchased assets claimed as expense and to increase allowable costs by depreciation allowable. (HCFA Pub. 15-1 Section 108; DMA Policies and Procedures, Appendix D)

COST CENTER Dietary Cost of Major Moveable Equipment Operation and Maintenance ofPlant Cost ofMajor Moveable Equipment Administrative and General Cost of Major Moveable Equipment Property and Related Expenses Allowable Depreciation Expense
Total Adjustment to Allowable Costs

$

(969)

(928)

(1,855)

654

$...............li(3_,0_9"",8)

1998 Audit Report: Metter Nursing Home

9

Costs Not Related to Patient Care

Finding No.5

Allowable costs claimed 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 allowable costs. We recommend that the provider implement policies and procedures to ensure that expenses claimed in the cost report do not include items not related to patient care. We recommend that the Department of Medical Assistance make the following adjustment to remove the non-patient care expenses from allowable costs.
(HCFA Pub.15-1 Sections 2102.1, 2102.3, 2122.2, 2136.2, 2139; DMA Policies and Procedures Section 1002.l(k

ITEMS Advertising Contributions to Political Action Committee Donations Non-Sufficient Funds Charges Property Taxes on Non-related Property

$

(708)

(50)

(134)

(452)

(386)

Total Adjustment to Allowable Costs

(1,730)

COST CENTER Administrative and General Property and Related Expenses
Total Adjustment to Allowable Costs

$

(1,344)

(386)

$-=======.(1==,7..3..0. .)

Finding No.6

Allocationsfrom Home Office
The provider was a component of a chain organization for the year ended June 30, 1998. As a result of our audit of the home office cost report filed in connection with the Medicaid Nursing Home Facilities Program, we recommended that the Department of Medical Assistance make adjustments to the allowable costs

10

Nursing Facility Services Program

claimed by the home office. We recommend that the provider and its home office implement policies and procedures to ensure that only allowable costs are allocated from the home office to the provider. We recommend that the Department of Medical Assistance make the following adjustment to correct allowable costs to reflect the allocation of the adjustments made to the home office cost report.
(HCFAPub.15-1 Section 2150)

COST CENTER Administrative and General Functionally Allocated Costs Pooled Costs Allocation Statistics Administrative Expenses
Total Adjustment to Allowable Costs

$

$

230

(3,865)

(690) (3,635)

$-=========(4..,3..=25==)

Lack ofSufficient Documentation

Finding No.7

Some of the expenses included in allowable costs were not supported by adequate documentary evidence. Federal regulations provide that cost information as developed by the provider must be current, accurate, and in sufficient detail to support payments made for services rendered to beneficiaries. We recommend that the provider implement policies and procedures to ensure that all expenses
shown on the cost report are supported by sufficient documentation. We
recommend that the Department of Medical Assistance make the following adjustment to remove the undocumented expenses from allowable costs.
(HCFA Pub. 15-1 Section 2304)

COST CENTER Administrative and General

$-=======(=5=3=2=)

1998 Audit Report: Metter Nursing Home

11

Patient Day Statistics

Finding No.8

Census records examined during the audit showed that the nursing home had 31,344 patient days of service rather than the 31,332 shown on the cost report. Federal regulations provide that cost information as developed by the provider must be current, accurate, and in sufficient detail to support payments made for services rendered to beneficiaries. We recommend that the provider implement policies and procedures to accumulate accurate patient day statistics. We recommend that the Department of Medical Assistance make the adjustment of 12 days to correct the statistical information.
(HCFA Pub. 15-1 Section 2304)

Accounts Receivable Credit Balances

Finding No.9

Documentation examined during the audit showed that the provider had numerous credit balances in its individual accounts receivable. Credit balances in the facility's accounts receivable result from overpayments for services provided to its patients. The $58.45 shown in the following table represents overpayments from the Department of Medical Assistance that had not been resolved as of January 31, 1999. We recommend that the provider review its credit accounts receivable and refund overpayments to the appropriate party. We further recommend that the provider implement policies and procedures' to ensure that overpayments on patients' accounts are promptly refunded to the payor. We also recommend that the Department of Medical Assistance review this matter and recover any overpayments identified.

Patient Name George, Armetta

Balance $========58=.4==5

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Nursing Facility Services Program

SUMMARY OF AUDIT FINDINGS AFFECTING ALLOWABLE COSTS AND PATIENT DAY STATISTICS

1998 Audit Report: Metter Nursing Home

13

FINDING NUMBER

ALLOWABLE COSTS

Administrative and General

1

Incorrect Expense Classifications

$

(3,346)

2

Accrual Basis ofAccounting

207

3

Nurse Aide Testing and Training Costs

(100)

4

Fixed Asset Purchases Claimed as Expense

(1,855)

5

Costs Not Related to Patient Care

(1,344)

6

Allocations from Home Office

(4,325)

7

Lack of Sufficient Documentation

(532)

(11,295)

Property and Related Expenses

1

Incorrect Expense Classifications

$

367

2

Accrual Basis ofAccounting

(605)

4

Fixed Asset Purchases Claimed as Expense

654

5

Costs Not Related to Patient Care

(386)

30

Total Audit Findings Affecting Allowable Costs

$- _...(..8..,=75=4)

PATIENT DAY STATISTICS

8 Patient Day Statistics

12

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Nursing Facility Services Program

SCHEDULE OF ALLOWABLE COSTS AND PATIENT DAY STATISTICS

ALLOWABLE COSTS

COST REPORT TOTALS

FIELD AUDIT FINDINGS

AUDITED TOTALS

Routine Services

$ 949,292 $ (2,361) $ 946,931

Special Services

49,976

1,611

51,587

Dietary

222,104

2,260

224,364

Laundry and Housekeeping

110,448

444

110,892

Operation and Maintenance ofPlant

97,329

557

97,886

Administrative and General

295,910

(11,295)

284,615

Property and Related Expenses

69,846

30

69,876

Total Allowable Costs

$ 1,794,905 $ (8,754) $ 1,786,151

PATIENT DAY STATISTICS

31,332

12

31,344