1 north carolina office of the state auditor excellence, responsibility, can-do attitude, &...
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North Carolina Office of North Carolina Office of the State Auditorthe State Auditor
Excellence, Responsibility,
Can-Do Attitude, & Teamwork
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PERFORMANCE AUDIT
Department of Correction
Inmate Medicaid Eligibility
Presented byPresented byBeth A. Wood, CPA, State AuditorBeth A. Wood, CPA, State AuditorNorth Carolina Office of the State North Carolina Office of the State
AuditorAuditor
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DOC Wasting Money on Medical Care
http://abclocal.go.com/wtvd/video?id=7627758
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Where Did the Idea Come From?Where Did the Idea Come From?
• State Auditor Directive to Find Cost State Auditor Directive to Find Cost SavingsSavings
• Iowa Efficiency Review Iowa Efficiency Review – Public Works December 2009Public Works December 2009– Claim federal reimbursement forClaim federal reimbursement for
eligible inmate hospital careeligible inmate hospital care
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Where Did the Idea Come From?Where Did the Idea Come From?
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What Was Happening in What Was Happening in North Carolina?North Carolina?
• A 2010 North Carolina Office of the State Auditor A 2010 North Carolina Office of the State Auditor Fiscal Control Audit revealed:Fiscal Control Audit revealed:– Hospitals were billing the Department of Correction:Hospitals were billing the Department of Correction:
• On average 467% of Medicare/Medicaid ratesOn average 467% of Medicare/Medicaid rates• Ranging between 198% to 879% of Medicare/Medicaid ratesRanging between 198% to 879% of Medicare/Medicaid rates
• Q: Can Inmates Participate in Medicaid?Q: Can Inmates Participate in Medicaid?• A: “Inmates Are Not Eligible for Medicaid”A: “Inmates Are Not Eligible for Medicaid”
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North Carolina Medicaid Plan
Source: http://www.ncdhhs.gov/dma/plan/m.pdf
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Federal Guidance
Source: http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2010-7260.pdf
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Audit Objective
• To determine if the Department could To determine if the Department could reduce inmate health care cost,reduce inmate health care cost,
• By requiring hospitals and other medical By requiring hospitals and other medical service providers to bill Medicaid for service providers to bill Medicaid for eligible inmate inpatient hospital and eligible inmate inpatient hospital and professional services.professional services.
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Audit ScopeAudit Scope
• The audit scope included:The audit scope included:– the Department’s inmate medical costs, andthe Department’s inmate medical costs, and– inmate medical information for calendar inmate medical information for calendar
years 2008 and 2009. years 2008 and 2009.
• We conducted the fieldwork from March to We conducted the fieldwork from March to June 2010.June 2010.
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What Did We Do?What Did We Do?
• Obtained a Letter from the Centers for Medicare Obtained a Letter from the Centers for Medicare & Medicaid Services to Clarify Federal & Medicaid Services to Clarify Federal Regulations Concerning Inmate Medicaid Regulations Concerning Inmate Medicaid Eligibility Eligibility
• Interviewed Department of Health and Human Interviewed Department of Health and Human Services, Division of Medical Assistance StaffServices, Division of Medical Assistance Staff
• Interviewed Personnel from States That Charge Interviewed Personnel from States That Charge Medicaid for Inmate Health Care CostsMedicaid for Inmate Health Care Costs
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What Did We Do?
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What Did We Do?
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What Did We Do?
• Obtained the Services of Specialists to:Obtained the Services of Specialists to:– Identify inmates receiving inpatient medical care for Identify inmates receiving inpatient medical care for
2008 & 2009 2008 & 2009 – Identify doctor fees related to inpatient staysIdentify doctor fees related to inpatient stays– Review inmate’s demographics and medical recordsReview inmate’s demographics and medical records– Identify inmates who were likely Medicaid eligible Identify inmates who were likely Medicaid eligible – Compared what was paid vs. what should have been Compared what was paid vs. what should have been
paid under Medicaid ratespaid under Medicaid rates– Removed FFP to get the state portionRemoved FFP to get the state portion– Calculate potential savingsCalculate potential savings
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What Did We Find?What Did We Find?
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What Did We Find?What Did We Find?
• Inmate Health Care Cost Savings of $11.5 Inmate Health Care Cost Savings of $11.5 Million a Year.Million a Year.
• Amount Is Equal to the Office of the State Amount Is Equal to the Office of the State Auditor’s Annual Appropriation.Auditor’s Annual Appropriation.
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RecommendationsRecommendations
• Bill Eligible Inmate Inpatient Health Care Bill Eligible Inmate Inpatient Health Care Costs to MedicaidCosts to Medicaid
• Determine Inmate Medicaid Eligibility and Determine Inmate Medicaid Eligibility and Prevent Eligibility TerminationPrevent Eligibility Termination
• Savings Possible for Local Governments Savings Possible for Local Governments
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New LegislationNew Legislation
• Requires Department to Use Medicaid For Requires Department to Use Medicaid For Eligible Inmates Eligible Inmates
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UpdateUpdate
The audit that “KEEPS ON GIVING”!!!!
• 1ST Nine months of implementation
• 997 Medicaid Cards Illegal??
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Performance AuditPerformance Audit
Audit of the State’s Performance Management Program (PMP)
• Department of Transportation
• Department of HHS (2 Divisions)
• Department of Public Instruction
Represents 48% of 98,000 State Employees
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Where Did the Idea Come From?Where Did the Idea Come From?
• Experience with Office of State Treasurer, Office of State Auditor
• Office of State Personnel Report
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Audit ObjectivesAudit Objectives
• Whether the performance management system is adequately monitored, and
• Whether selected state agencies effectively administer the performance management system.
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Audit ScopeAudit Scope
• Administration of Program During FY 2008
• We conducted the fieldwork from April 2009 to February 2010.
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What Did We Do?What Did We Do?
To Determine if Program Adequately Monitored OSA Interviewed Personnel at:
• The Office of State Personnel,
• The Department of Correction,
• The Department of Health and Human Services,
• The Department of Transportation, and
• Members of the General Assembly
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What Did We Do?What Did We Do?
To Determine Whether Agencies Effectively Adminstered the Program OSA :
• Selected Sample of Performance Appraisals
• Selected Tested All Appraisals with “BG” or Unsatisfactory Ratings
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ResultsResults
1. Monitoring Not Adequately Done By Agencies
• Performance Management Coordinators Did Not Review a Sample Appraisals
• DOT Did Not Have Written Policies
• Agencies Did Not Evaluate PMP
State Personnel Did Not Monitor Agencies
General Assembly Did Not Monitor
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ResultsResults
Costs
• DHHS – 94,000 hours; $2.5 M
• DOT - 50,000 hours; $1.3 M
• DOC - 82,000; $1.5 M
Employees Underperforming Still Working
Employees Underperforming - Raises
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RecommendationsRecommendations
1. Agencies Should Have Policies and Procedures for Reviewing
2. Agencies Should Be Monitoring Their System
3. OSP Should Be Monitoring Agencies
4. General Assembly Should Look at Revising the System
5. General Assembly Should Assess Oversight Committees
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ResultsResults
2. Agencies Did Not Effectively Administer PMP
• Did Not Provide Measureable Performance Expectations
• Did Not Provide Written Development Plans
• Did Not Adequately Documented Corrective Action Plans
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RecommendationsRecommendations
• Agencies Should Ensure That Staff are Provided with Measureable Performance Expectations
• OSP Should Require Written Development Plans
• Agencies Should Ensure Documentation of Corrective Action Plans Happens
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OSA StrategyOSA Strategy
• Ensure General Assembly “Irrefutable Findings”
• Presentations Made to General Assembly
• Supervisors and Managers Attend Presentations
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Questions?Questions?
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North Carolina Office North Carolina Office of the State Auditorof the State Auditor
Public Website: www.ncauditor.netPublic Website: www.ncauditor.net
or by contacting:or by contacting:
Bill StyresBill Styres
Performance Audit ManagerPerformance Audit Manager
919-807-7500919-807-7500
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North Carolina Office North Carolina Office of the State Auditorof the State Auditor
Bill Styres, CPMBill Styres, CPM
Performance Audit SupervisorPerformance Audit Supervisor
919-807-7580919-807-7580