The state Legislative Audit Division questioned $1.3 million in health services in an audit of the state Medicaid program Friday because documentation was not filled out properly.
State Medicaid Director Andy Allison told the Legislative Joint Auditing Committee that the agency disagrees with the findings and believes the audit overstated the problem. In most cases, he said, health-care workers simply forgot to sign or date a form.
Some committee members questioned why the Medicaid program disputed the findings, noting that similar problems have arisen in past audits.
“Auditors found insufficient data, so what are wedoing to move forward so we don’t have to come back here every time?” asked Vice-Chairman Sen. Linda Chesterfield, D-Little Rock.
Allison said there are consequences to the state Medicaid program agreeing with Legislative Audit findings.
“We would have to take that money back from the provider,” Allison said. “So we are actually acting on both our own behalf and the provider’s behalf to make sure that any recoupments, which means taking money back from providers who actually provided the service, are appropriate.”
The $1.3 million identified in the audit is a fraction of the more than $230 million in home and community services grants, Allison said.
After nearly two hours,the committee referred the audit to its Medicaid Subcommittee for more discussion.
The audit looked at three programs that provide services to the elderly and the developmentally or physically disabled.
Required documentation for the programs includes a copy of the beneficiaries’ care plan, a description of the service, the name and title of the person providing the service, progress updates, and the date and actual time of the service.
Medicaid’s Chief Financial Officer Tommy Carlisle said that some mistakes are goingto occur.
“It’s a very daunting task, because you’re talking about, just in these few small programs, thousands and thousands and thousands of pages of documentation,” Carlisle said. “This is not a material weakness.”
The errors that have been uncovered are minor, he said.
“We don’t dispute that there was a document without a signature on it, but we do dispute that it was an improper payment to that provider,” Carlisle said.
Allison said an internal review of Legislative Audit’s sample showed that health services were properly delivered, but there were problems with missing dates or signatures.
“With further review, in very few cases do we find that the service wasn’t provided or that there was fraud,” Allison said. “It really is just a matter of documentation and interpretation of the requirements for documentation.”
Medicaid’s written response to the audit states that the agency will work to train providers to fill out the forms correctly and increase the number of home visits by staff members to check that services are being provided.
Lawmakers passed several bills during the 2013 Legislative session aimed at overhauling the state’s $5 billion Medicaid program, which serves 780,000 people.
That includes Act 1499,which created an independent Medicaid inspector general within the governor’s office to oversee Medicaid-related fraud and abuse investigations.The inspector will investigate and refer cases for criminal prosecution, recover funds and audit medical-assistance programs. It also created felony penalties for committing health-care fraud. The new law also requires the inspector general to report annually to the Legislature, governor and attorney general.
Act 1265 set up an electronic Medicaid eligibility system that checks Social Security numbers, prison records and tax returns to verify whether an applicant is eligible for benefits.
Northwest Arkansas, Pages 11 on 05/11/2013