A P ERFORMANCE A UDIT OF T HE D IVISION OF R EHABILITATION S ERVICES - - PowerPoint PPT Presentation

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Office of the

Utah State Auditor

A PERFORMANCE AUDIT OF THE DIVISION OF REHABILITATION SERVICES COST CONTROLS

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Office of the

Utah State Auditor

Mission Statement

We provide Utah taxpayers and government officials with an independent assessment of financial

• peration, statutory compliance, and

performance management for state and local government.

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Office of the

Utah State Auditor

Controls Reviewed

• Vehicle Modifications
• Direct Authorizations
• Medical Expenditures
• Identity Verification

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Office of the

Utah State Auditor

Background

• DRS Established in 1921
• Assists Disabled Clients

Obtain/Retain Employment

• VR Disability = “Substantial

Impediment to Employment”

• Reports to the State Board of

Education

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Office of the

Utah State Auditor

Background

$- $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 $35,000,000 Administrative Costs Program Costs

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Office of the

Utah State Auditor

Finding 1: Noncompliance with Policy Leads to Questionable Vehicle Modifications

• None of the 15 Vehicle Modifications

Complied with Policy

• Spent $516,000 on Vehicle

Modifications

• May Have Prevented Several Vehicle

Modifications by Following Policy

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Office of the

Utah State Auditor

Finding 1: Noncompliance with Policy Leads to Questionable Vehicle Modifications

• DRS Counselor Did not Consider Existing

Client Resources Prior to Authorizing:

– Vehicle Modifications ($23,000) – Home Elevator ($16,000)

• Client’s Job Was not in Jeopardy
• Client Did not Return to Former Job After

Receiving Services

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Office of the

Utah State Auditor

Finding 1: Noncompliance with Policy Leads to Questionable Vehicle Modifications

• Counselors Do Not Document

Alternatives to Vehicle Modifications

• Lack of Coordination with Public

Transportation

• Clients Do Not Return Assets if they

Change Employment Objective

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Office of the

Utah State Auditor

Finding 1 Recommendations

• Increased Review and Accountability

for Vehicle Modifications

• Improved Coordination with Public

Transportation Entities

• Verification of Income and Assets
• Reclaim Assets Not Used for an

Employment Objective

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Office of the

Utah State Auditor

Finding 2: Noncompliance with Direct Authorization Policy Increases Fraud Risks

• Issued $350,000 in Direct Authorizations
• Could Reduce Fraud Risks by Limiting

Direct Authorizations

• Direct Authorizations Include:

– Food – Shelter – Transportation

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Office of the

Utah State Auditor

Finding 2: Noncompliance with Direct Authorization Policy Increases Fraud Risks

November – December 2010 Tires, inspection, and licensing for Car A and gas for Car B November 2011 Gas for Car B and licensing for Car A August 2012 Gas for Car C August 2010 Gas for Car A June 2011 Tires for Car C March 2012 Tires for Car C 2012 2011 2010 October 2010 Tires and gas for Car A September 2010 Gas for Car A January 2011 Gas for Car A December 2011 Gas for Car B January & April 2012 Gas for Car B and gas for Car C February 2012 Gas for Car B May 2012 Gas for Car C September 2012 Licensing, inspection, and insurance for Car C October 2012 – June 2013 Gas for Car C

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Office of the

Utah State Auditor

Finding 2 Recommendations

• Increased Review and Accountability

for Direct Authorizations

• Improved Documentation for Use of

Direct Authorizations

• Reimbursement of Difference

Between Funds Authorized and Funds Spent by Client

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Office of the

Utah State Auditor

Finding 3: The DRS Could Reduce Costs and Improve Controls by Contracting Medical Functions

• Charging Medicaid Rate Would

Reduce Medical Costs $612,000/Year

• Using Medical Claims System Could

Decrease Risks

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Office of the

Utah State Auditor

Finding 3: The DRS Could Reduce Costs and Improve Controls by Contracting Medical Functions

CPT Code Procedure DRS Rate Utah Medicaid Rate (Traditional) Percent Difference 99213 Outpatient Visit $78.66 $51.65 53.2% 99203 Outpatient Visit $116.84 $76.87 52.0% 99214 Outpatient Visit $118.22 $75.93 55.7% 99205 Outpatient Visit $227.24 $145.87 55.8% 99204 Outpatient Visit $179.86 $117.64 52.9% 99215 Outpatient Visit $159.16 $101.81 56.3%

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Office of the

Utah State Auditor

Finding 3: The DRS Could Reduce Costs and Improve Controls by Contracting Medical Functions

CPT Code Procedure DRS Rate Utah Medicaid Rate (Traditional) Utah Medicaid Rate (Primary Care Network) 90801 Psychiatric Exam $200.10 Discontinued Discontinued 90805 Psychotherapy $92.00 Discontinued Discontinued 90862 Pharmacologic Management $73.14 Discontinued Discontinued 90802 Interactive Psych Interview $212.52 Discontinued Discontinued

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Office of the

Utah State Auditor

Finding 3 Recommendations

• Contract with Medicaid to Process

Medical Claims and Access Medical Consultants

• Adopt and Use the Medicaid Fee

Schedule

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Office of the

Utah State Auditor

Finding 4: Identity Verification Could Support Client Employment and Reduce Potential Fraud

• Verifying Identity Would Ensure that

Clients:

–Are Properly Identified –Are Eligible to Obtain Employment –Possess Necessary Documentation

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Office of the

Utah State Auditor

Finding 4: Identity Verification Could Support Client Employment and Reduce Potential Fraud

State Requires Identification Documents Verifies Identity as a Best Practice Does Not Verify Client Identity Arizona X Colorado X Idaho X Nevada X New Mexico X Utah X Wyoming X

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Office of the

Utah State Auditor

Finding 4 Recommendation

Ensure that DRS Clients have Adequate ID to Verify Identity Required to Obtain Employment

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Office of the

Utah State Auditor

Recommendation

We recommend that the Legislature evaluate the current organizational alignment and reporting structure for the state's vocational rehabilitation program to ensure appropriate

• versight and mission alignment.

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Office of the

Utah State Auditor

QUESTIONS?

AUDITOR.UTAH.GOV