Audit report, for the year ended January 31, 1994, Primary Health Care Center of Dade, Inc., Medicaid provider number 00211956A, Community Health Center Services Program [Jan. 31, 1994]

DEPARTMENT OF AUDITS Medicaid and Local Government Audits
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AUDIT REPORT FOR THE YEAR ENDED JANUARY 31, 1994 PRIMARY HEALTH CARE CENTER OF DADE, ~NC.
MEDICAID PROVIDER NUMBER 00211956A COMMUNITY HEALTH CENTER SERVICES PROGRAM

TABLE OF CONTENTS
LETTER OF TRANSMITTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
FINDINGS AND RECOMMENDATIONS ................... 3 Summary of Audit Findings Affecting Allowable Costs and Patient Visit Statistics 7 Schedule of Allowable Costs and Patient Visit Statistics 9 Reconciliation of Medicaid Reimbursement for Core Services . . . . . . . . . . . . . . . . 10

A.UDE L VICKERS
STAle AUDITOR

DEPARTMENT OF AUDITS
254 Washington Street, S.W., Suite 214 Atlanta, Georgia 30334-8400
Telephone (404) 656-2006 Facsimile (404) 656-7535
February 29, 1996

Members of the Board ofMedical Assistance, and The Honorable Marge Smith, Commissioner Department ofMedical Assistance 2 Peachtree Street, N.W., Suite 27-100 Atlanta, Georgia 30303
Ladies and Gentlemen:
This report provides the results of our audit of Primary Health Care Center of Dade, Inc., provider number 00211956A, a participant in the Community Health Center Services Program for the year ended January 31, 1994. This report is intended to be used solely in connection with the administration ofthe Georgia Department ofMedical Assistance Community Health Center Services Program and is not to be used or relied upon for any other purpose.
Respectfully Submitted,

CLV/fd/by

Claude L. Vickers State Auditor

1994 Audit Report: Primary Health Care Center of Dade, Inc.

1

INTRODUCTION

Provider Information Audit Objectives

Primary Health Care Center of Dade, Inc., is a Federally Qualified Health Center (FQHC) located in Trenton, Georgia. The center provides a full range of primary diagnostic and therapeutic services (core services) that are reimbursed through an all-inclusive per encounter rate. The center was operated as a freestanding FQHC for the year ended January 31, 1994.

The purpose of this audit was to determine whether Primary Health Care Center of Dade, Inc., a provider enrolled in the Georgia Medicaid Community Health Center Services (CHCS) Program, maintained adequate documentation to support the allowable costs and patient visit statistics reported in its Federally Qualified Health Center Cost Report for the year ended January 31, 1994; and to determine whether Primary Health Care Center of Dade, Inc., complied with the federal and state laws, regulations, policies and procedures for the CHCS Program in effect for that period. The specific objectives of this audit were to:



determine if allowable costs reported in the Federally

Qualified Health Center Cost Report are reasonable

and allowable, in all material respects, in accordance

with federal and state laws, regulations, policies and

procedures governing the Georgia Community Health

Center Services Program;

2
Scope and Methodology

Community Health Center Services Program



detennine if patient visit statistics included in the cost

report are accurately reported;



determine the amount of any settlement between

Primary Health Care Center of Dade, Inc., and the

Department ofMedical Assistance based on payment

information provided by the Department of Medical

Assistance; and



recommend appropriate action based on the results of

our audit.

To accomplish these objectives, we interviewed provider personnel and examined records and documentation to determine the adequacy of amounts and disclosures included in the Federally Qualified Health Center Cost Report. We performed a limited review of the provider's internal control structure to the extent necessary to plan our audit. 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 OMA Policies and Proceduresfor Community Health Center Services. We also obtained information from the Department of Medical Assistance related to the number of paid Medicaid visits and the total amount paid for those visits.

1994 Audit Report: Primary Health Care Center of Dade, Inc.

3

FINDINGS AND RECOMMENDATIONS

Finding No. I

Incorrect Expense Classifications

Documentation examined during the audit showed that some ofthe expenses were not properly classified. 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 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.
(HCFA Pub. 15-1 Section 2304; Instructions to the Cost Report)

COST CENTER

FQHC Core Services

Administrative Costs

$

Travel Expense

FQHC Overhead - Facility Costs

Travel Expense

FQHC Overhead - Administrative Costs

Administrative Costs

(534) (68) $

(602) 68 534

Total Adjustment to Allowable Costs

$=====I=

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

4

Community Health Center Services Program

make the following adjustment to decrease allowable costs claimed for expenses not applicable to the year under review.
(HCFA Pub. 15-1 Section 2302.1)

Adjustments to Balance Sheet Accounts:

Allowable Costs

January 31, 1993 Balance Accounts Payable

s,==::::::!r:!,2!!1:0!:i!:=2=:!1==}

January 31, 1994 Balance Accounts Payable
Total Adjustment to Allowable Costs

$=====78~3= $==='!1r::::!1::l:!3::!:::!0~8~)

COST CENTER FQHC Core Services FQHC Overhead - Facility Costs FQHC Overhead - Administrative Costs
Total Adjustment to Allowable Costs

$

(2,016)

177

531

$==='!11::=1~3:!::!0:!:!:8!:c)

Finding No. 3

Lack ofSufficient Documentation
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)

1994 Audit Report: Primary Health Care Center of Dade, Inc.

5

COST CENTER FQHC Overhead - Facility Costs FQHC Overhead - Administrative Costs
Total Adjustment to Allowable Costs

$

(212)

(457)

$.===='6!=!::!6!!:9:z:::)

Finding No.4

Costs Not Related to Patient Care

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 2102.3)

ITEMS Advertising Association Dues (50%) Civic Organization Dues Expenses of Another Entity

$

(2,451)

(793)

(150)

(333)

$==='~3:::1::7!:!!2!!:!7:z:)

COST CENTER FQHC Overhead - Facility Costs FQHC Overhead - Administrative Costs
Total Adjustment to Allowable Costs

$

(333)

(3,394)

$==='~3:::1::7!:!!2!!:!7:z:)

6

Community Health Center Services Program

Finding No. 5

Medicaid Patient Visit Statistics
Census records examined during the audit showed that the center had 1,057 Medicaid patient visits rather than the 892 shown on the cost report. Federal regulations provide that cost infonnation 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 Medicaid patient visit statistics. We recommend that the Department of Medical Assistance make the adjustment of 165 Medicaid visits to correct the statistical infonnation.
(HCFA Pub. 15-1 Section 2304)

Finding No. 6

Total Patient Visit Statistics
Census records examined during the audit showed that the center had 6,468 total patient visits rather than the 5,641 shown on the cost report. Federal regulations provide that cost infonnation 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 visit statistics. We recommend that the Department of Medical Assistance make the adjustment of 827 visits to correct the statistical infonnation.
(HCFA Pub. 15-1 Section 2304)

1994 Audit Report: Primary Health Care Center of Dade, Inc.

7

SUMMARY OF AUDIT FINDINGS AFFECTING ALLOWABLE COSTS AND PATIENT VISIT STATISTICS

FINDING NUMBER

ALLOWABLE COSTS

Federally Qualified Health Center Core Services

1

Incorrect Expense Classifications

2

Accrual Basis of Accounting

$

(602)

(2,016) $

FOHC Overhead-Facility Costs

1

Incorrect Expense Classifications

2

Accrual Basis of Accounting

3

Lack of Sufficient Documentation

4

Costs Not Related to Patient Care

$

68

177

(212)

(333)

FOHC Overhead -Administrative Costs

1

Incorrect Expense Classifications

2

Accrual Basis of Accounting

3

Lack of Sufficient Documentation

4

Costs Not Related to Patient Care

$

534

531

(457)

(3,394)

Total Audit Findings Affecting Allowable Costs

$

(2,618)
(300)
(2,786)
,s 2Q~)

MEDICAID PATIENT VISIT STATISTICS

5 Increase in Medicaid Visit Statistics

165

8

Community Health Center Services Program

FINDING NUMBER

TOTAL PATIENT VISIT STATISTICS

6 Increase in Total Patient Visit Statistics

827

1994 Audit Report: Primary Health Care Center of Dade, Inc.

9

SCHEDULE OF ALLOWABLE COSTS AND PATIENT VISIT STATISTICS

ALLOWABLE COSTS FQHC Core Services
FQHC Overhead - Facility Costs FQHC Overhead - Administrative
Costs Total FQHC Overhead

COST REPORT TOTALS

AUDIT FINDINGS

AUDITED TOTALS

$ 303,256 $

$

56,452 $

216,940 $ 273 ,392 $

(2,618) $- -30-0,63-8

(300) $

56 , 152

(2,786) (3,086) $

214 , 154 270,306

Total Allowable Costs

$ 576,648 $

(5,704) $==57=0,=9=44=

l\IBDICAID PATIENT VISIT STATISTICS

892

165

1,057

TOTAL PATIENT VISIT STATISTICS
I

5,641

827

6,468

Community Health Center Services Program

RECONCILIATION OF MEDICAID REIMBURSEMENT FOR CORE SERVICES

Total Allowable Cost ofFQHC Core Services (page 9) Total Patient Visits (page 9)
Allowable Cost per Patient Visit
Maximum Allowable Cost per Patient Visit (1)
Lower of Allowable or Maximum Cost per Patient Visit Total Visits by Medicaid Patients (2) Total Allowable Costs for Visits by Medicaid Patients Interim Payments by the DMA (2) Amount Due to/(from) Provider

$ 570,944 6,468

$

88 .27

$

76.82

$

76.82

1,057

$

81,199

76,707

$

4,492

(1) This amount represents the maximum allowable amount as established by the Department of Medical Assistance in accordance with Policies and Procedures Section 1001 .3.
(2) This information was furnished to us by the Department of Medical Assistance.