FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS
EMPLOYEES LACK REQUIRED TRAINING
Departmental guidelines require Center employees to attend refresher
training courses, periodically, on topics including aggression
management, restraints, CPR, infection control, and crisis prevention. Training is an
important element that can enable Center employees to perform their duties properly.
Twenty-three (23) percent of the employees who completed the required refresher
training were delinquent and should have attended the training about 7 months earlier, on
average.
We recommend the Center ensure its employees receive the required training in
accordance with existing policies. (Finding 1, pages 9-10)
According to management’s response, all staff are fully trained prior to assuming
direct care of patients, and Departmental policies and procedures for refresher training
courses are in place. Overtime considerations were cited by management as hindering the
timely scheduling of refresher training. Management stated that refresher training for all
employees will be completed by July 1, 2002.
MEDICARE NOT BILLED FOR SOME ELIGIBLE PHYSICIAN SERVICES
The Center did not submit reimbursement requests to Medicare for 15 out of 40
(37.5%) physician services tested. We estimated approximately $94,000 of lost Medicare
reimbursement during the audit period.
Center officials indicated that some medical services were not billed because the
nursing staff was not filing all of the Medicare service slips with the Medical Records
Unit of the Center.
We recommended the Center emphasize to nursing staff the need to prepare and submit
Medicare service slips for all physician services performed on behalf of eligible
patients. We also recommended the Center periodically review its resident files for
possible unbilled physician services. Management should follow up on any eligible, but
unbilled services. (Finding 2, page 11)
According to the response, Center officials accepted our recommendation and stated they
will retrain the nursing staff on preparation and submission of medical service slips. In
addition, officials stated that procedures including a quarterly review for unbilled
physician services will be finalized in March, 2002.
INADEQUATE FOLLOW-UP ON REJECTED MEDICARE BILLINGS FOR LAB SERVICES
During our audit, we noted 1,725 rejected Medicare claims for laboratory services,
totaling $18,967. This represented approximately 18 percent of the Center’s filings
for reimbursement of laboratory services. Center staff had no documentation that the
rejected claims were reviewed for propriety.
The Center has a statutory duty to aggressively pursue collection of all amounts due
and payable to the State of Illinois. We recommended the Department of Human Services work
to achieve better communication on laboratory billings with the Medicare claims office,
and that the Center allocate sufficient resources to investigate rejected Medicare claims.
(Finding 3, page 12)
Management accepted our recommendation, stating that procedures will be finalized in
March 2002, to include a monthly review of rejected Medicare claim for lab services, for
possible resubmission.
PUBLIC HEALTH RECOMMENDS TERMINATION OF CENTER’S MEDICAID AGREEMENT
In October 2001, after completing a survey, the Illinois Department of Public
Health reported that the Center was not in compliance with four of the eight Conditions of
Participation. Public Health recommended that the Department of Public Aid terminate its
Medicaid Agreement with the Center.
Previously, the Center had received about $17 million annually in Medicare
reimbursements. Termination by Public Aid would halt federal Medicaid reimbursement for
Center residents and would threaten closure of the Center.
Below are some instances of noncompliance with the Conditions of Participation, as
identified in October 2001 during Public Health’s survey.
- Some residents were not properly supervised, and some residents were ingesting inedible
objects without intervention. These observations resulted in an immediate jeopardy
citation on the second day of Public Health’s survey.
- The Center’s deployment of staff was not sufficient to ensure that residents had
necessary services and a safe environment. Individuals were found with injuries of unknown
origin.
- There was a lack of implemented programs based on individual needs and a lack of
meaningful and functional activities.
After Public Health’s survey, the Illinois Department of Human Services assigned a
new management team to the Center. In February 2002, the Governor announced that the
Center would stay open with a reduced residential headcount. (Finding 4, pages 13 –
15)
Center management accepted our recommendation to continue to pursue the reforms ordered
by the Governor and work with the Illinois Departments of Public Health and Public Aid to
comply with all the Conditions of Participation.
OTHER FINDINGS
The remaining finding and recommendation is less significant and is being given
attention by Center management. We will review progress toward implementation of our
recommendations during our next audit.
Mr. James R. Donkin, Chief Internal Auditor for the Department of Human Services,
provided the Department responses.
AUDITORS' OPINION
We conducted a compliance audit of the Center as required by the
Illinois State Auditing Act. We also performed certain agreed-upon procedures with respect
to the records of the Center to assist our audit of the entire Department of Human
Services. Financial statements for the Department are included in the audit report of the
Department of Human Services – Central Office.
_____________________________________
WILLIAM G. HOLLAND, Auditor General
WGH:JHL:pp
SPECIAL ASSISTANT AUDITORS
Our special assistant auditors were Hurst, Wright & Hafel LLP.
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