DEPARTMENT OF HEALTH CARE

SERVICES

Audits & Investigations – Financial Audits Branch

Presented by:

Gary Diffenderffer, CIAHealth Program Audit Manager

Introduction:

Financial Audits Branch (FAB) Cost Report Process:

Submission Acceptance Approval

Results of Acceptance/Approval Process Audit Issues

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.

Cost Report Flow: Submission of Cost Report

Acceptance Acceptance Letter

Approval Approval Letter

Begin Invoicing TCM Program

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)

TCM Cost Reports - Submission Hard Copy* – Includes, but not limited to the

following: Cover Letter Certification Statement Cost Report (Signed) / Including Funding Schedule Time Survey Template

List Worksheet Totals Worksheet Time Sheets

Cost Report Review Tool Supporting Documentation

*Refer to TCM Cost Report Instructions - 2008

TCM Cost Reports - Submission Soft Copy – Includes the following completed

items: Cost Report Template Survey Template

List WorksheetTotals WorksheetTime Sheets

Funding Schedule Cost Report Review Tool Template

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

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

TCM Cost Reports - Acceptance Acceptance Process :

Acceptance Letter issued by ARAS

Acceptance Letter LGA

For each TCM Cost Report (LGA and CBO)

Identifies “postmark date” to establish 36-month audit period

TCM Cost Reports - Acceptance Top reasons cost report was not accepted upon first

review:

1. Did not include “TCM encounters by month”2. IRS Form 990 not included3. Electronic copy of Worksheet A did not match

hard copy4. Complete Table of Contents not included5. Financial statements for CBO not included6. Electronic copy of Cost Report not submitted

TCM Cost Reports - Approval Approval Process :

Responsibility of Audits Section - SacramentoReview of checklist completed by ARASIdentification of “potential” audit issues for

future auditsIssuance of Approval Letter

TCM Cost Reports - Approval Approval Process :

Approval Letter issued by Audits Section – Sacramento

Approval LetterOne letter issued for each target population

served by an LGAPurpose of the letter is to establish:

TCM Rate Period (2008/2009) Rate Per TCM Encounter TCM Maximum Amount

TCM Program Type (06): Public Health

Rate Per TCM

TCM Rate Period TCM Encounter Maximum Amount FY 2008-2009 $250.55 $100,220.00

TCM Cost Reports - Approval

Approval Process :

(Excerpt from an Approval Letter)

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.

TCM Cost Reports – 2007-2008 Results

Month Approvals .

Current Yr Prior Yr

Nov 2007 0 0Dec 2007 25 28 Jan 2008 41 36Feb 2008 17 35Mar 2008 16 20Apr 2008 14 0May 2008 2 0Totals 115* 119*

*Reflects LGA “Approved” SPA Cost Reports; excludes CBO cost reports.

Audit Issues: Amended Cost Reports Denied Cost Reports Audits:

Cost Report Payments

Audits In Process: Certified Public Expenditure Status

Future Audits: Desk Field

Questions?

FAB Contact Information

Audit Review & Analysis Section (ARAS) Gary Wong, Chief

(916) 650-6687Gary.Wong@dhcs.ca.gov

Audits Section - Sacramento Gary Diffenderffer, Supervisor

(916) 650-6963Gary.Diffenderffer@dhcs.ca.gov

DEPARTMENT OF HEALTH CARE

SERVICES

Audits & Investigations – Financial Audits Branch

Presented by:

Gary Diffenderffer, CIAHealth Program Audit Manager