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DEPARTMENT OF HEALTH CARE SERVICES

DEPARTMENT OF HEALTH CARE SERVICES. Audits & Investigations – Financial Audits Branch Presented by: Gary Diffenderffer, CIA Health Program Audit Manager. Financial Audits Branch (FAB).

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DEPARTMENT OF HEALTH CARE SERVICES

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  1. DEPARTMENT OF HEALTH CARE SERVICES Audits & Investigations – Financial Audits Branch Presented by: Gary Diffenderffer, CIA Health Program Audit Manager

  2. Financial Audits Branch (FAB) • Responsible for providing program integrity of healthcare programs administered by the California Department of Health Care Services • Performs financial audits of Medi-Cal Providers (includes TCM) to ensure compliance with applicable laws, regulations, and program intent.

  3. Cost Report Flow: Submission of Cost Report Acceptance Acceptance Letter Approval Approval Letter Begin Invoicing TCM Program

  4. TCM Cost Reports - Submission • TCM Cost Reports due November 1st Hard Copy Audit Review and Analysis Section (ARAS) Soft Copy dhsaitcm@dhcs.ca.gov (Audits Section – Sacramento)

  5. TCM Cost Reports - Submission • Hard Copy* – Includes, but not limited to the following: • Cover Letter • Certification Statement • Cost Report (Signed) • Time Survey Template • List Worksheet • Totals Worksheet • Time Sheets • Cost Report Review Tool • Supporting Documentation *Refer to TCM Cost Report Instructions - 2007

  6. TCM Cost Reports - Submission • Soft Copy – Includes the following completed items: • Cost Report Template • Survey Template • List Worksheet • Totals Worksheet • Time Sheets • Cost Report Review Tool Template

  7. TCM Cost Reports - Acceptance • Acceptance Process : • Responsibility of ARAS: • Completion of five page checklist: • Reconcile reported amounts on “hard copy” to “soft copy” of the filed TCM cost report Hard Copy Soft Copy • Ensure cost report is “complete” in accordance with the current TCM Cost Report Instructions

  8. TCM Cost Reports - Acceptance • Acceptance Process: • Contact designated LGA Coordinator for missing and/or incorrect items. • Via email: Hello TCM Coordinator: Please send the requested information via email within the next 24 hours. Thanks, ARAS

  9. TCM Cost Reports - Acceptance • Acceptance Process : • Acceptance Letterissued by ARAS Acceptance LetterLGA • For each TCM Cost Report (LGA and CBO) • Identifies “postmark date” to establish 36-month audit period

  10. TCM Cost Reports - Acceptance • Top 10 missing documents, number 1 being the most common: • 1) Supplemental Encounter Schedule • 2) Funding Schedule • 3) IRS Form 990 • 4) “Hard copy” of cost report did not agree with “soft copy” (electronic) copy • 5) Complete CBO Contract

  11. TCM Cost Reports - Acceptance • Top 10 missing documents, number 1 being the most common: • 6) CWCAP • 7) Complete Table of Contents • 8) Financial Statements (CBO’s) • 9) Complete Cost Report Review Tool • 10) No “soft copy” / “hard copy” received

  12. TCM Cost Reports - Approval • Approval Process : • Responsibility of Audits Section - Sacramento • Review of checklist completed by ARAS • Identification of “potential” audit issues for future audits • Issuance of Approval Letter

  13. TCM Cost Reports - Approval • Approval Process : • Approval Letter issued by Audits Section – Sacramento • Approval Letter • One letter issued for each target population served by an LGA • Purpose of the letter is to establish: • TCM Rate Period (2007/2008) • Rate Per TCM Encounter • TCM Maximum Amount

  14. TCM Cost Reports - Approval Approval Process : (Excerpt from an Approval Letter) TCM Program Type (06): Public Health Rate Per TCM TCM Rate Period TCM EncounterMaximum Amount FY 2007-2008 $250.55 $100,220.00

  15. TCM Cost Reports - Approval • Approval Process : • Approval Letter issued by Audits Section – Sacramento LGA Approval Letter TCM Program* *The Approval Letter authorizes the TCM Program to accept an LGA’s invoice(s), and establishes, both, the approved rate per encounter and maximum amount.

  16. TCM Cost Reports – 2006-2007 Results FAB FAB Month Acceptance Approval Nov 2006 38 0 Dec 2006 46 28 Jan 2007 47 36 Feb 2007 16 35 Mar 2007 12 20 Totals 159 119* *Variance of 40 (159 – 119) reflects individual CBO cost reports.

  17. Audit Issues: • Amended Cost Reports • Audits: • Cost Report • Payments • Audits In Process: • Certified Public Expenditure • Status • Future Audits: • Desk • Field

  18. Questions?

  19. FAB Contact Information • Audit Review & Analysis Section (ARAS) • Gary Wong, Chief • (916) 650-6687 • Gary.Wong@dhcs.ca.gov • Audits Section - Sacramento • Gary Diffenderffer, Supervisor • (916) 650-6963 • Gary.Diffenderffer@dhcs.ca.gov

  20. DEPARTMENT OF HEALTH CARE SERVICES Audits & Investigations – Financial Audits Branch Presented by: Gary Diffenderffer

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