Corrective ActIon To Improve the accuracy ofthesummllY leave 8chedure, the TEn or Planned: Fl_ Management Oftlce Pre-AudItStaffwlfl be fncteatlngits randomrMwto apptOXlmatety15%ofthe2,OO
Trang 1leave records to eMU, that vacationandsldt leave record are accuratelymaintainedan atimely " is
Corrective ActIon To Improve the accuracy ofthesummllY leave 8chedure, the TEn or Planned: Fl_ Management Oftlce Pre-AudItStaffwlfl be fncteatlngits
randomrMwto apptOXlmatety15%ofthe2,OOO-plusemployee
1'8COfd1 Establishedpracedu requfrethatthe empCoyee re8POI'I8lb1Qformaintainingthe leavereCOfdstocomplteand
reviewthelnfGmlFltlon nGedGd!fortile summary leave schedule The appropriate8UJ.leNtSOJIsaJlo requIredtoreviewand 8Ign theworksheettoYlldIdeItacomp andaccuracy.
DHS willcontinuetoInsure PfOCecbe8 'egardlngtheapproval
pr00881ofteaw request are In compliancewfIhappropriate collective bargelnling unitagmment6and policiesand
procedure••
CHS wIll contII:'ue random auditaofleave records, tralni'1gofstaff perionnell1S8lQned the dutiesOfI'hafnlalnlngthe reave records and hlnlngof8LlpeMs.orypersonnelof leaverecords
Flespoflding Elol8e Uehara, PMO P AudltSblffSupeMSOf'
Persona: Phone: (808) 58&05020.and
Ed Nose PersonnelOlftcer
Phone: (808)688-4951
Ref.no.2OONI Mal Procunnent FUMPropIdy
AuditoI's We recommendthatprior,to collltractoraoeeplanee,UteDHS Recommendation: Implement a reviewproceMtoel18Uf$ procurementfire.contain
all docwnentatfon u requiredbyStateand federal pIOCUrement stades.
eorrecuveAction 1 The process for MODpropQll8~ review and acceptanceis Taken or Planned: b.,ng reviewed andad'1pted
2 Changesto the prooeutarPI'OPC*lIl'8V[1W Include:
a At1hestartofttl.procwementprOC8l8,an eleClRJnfc file for that procurementwiDbecreatedby the Ffnance Office
on a secllre drive
b Electronic fllas for eachatpectofthe procurement willbe
stored intheeteclrOnJcfile:AFI, RFP,Proposal
loomission,documentationthat sUPpOrts contractor seleclion or reject/on, and acopyof 1heexecuted contract. Onlymftmembel'ltIl81need the procurement
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Trang 2InformatIon will ht\ve access to,hefile.
c Upon completionofproposalreview.thescore8heet8wia
beIOIMeeiandliedelec1ronJcaJIy The orll)1nal score sheetIwlathenbehand delivered 10ContractOflIcerIn
tileMed-QUESTDiVIsion's FinanceOf6ce.
cL The conhet wlU not be executed without the score sheets
tosupportcontractawBfd
e A hardcopyfileofall documents wlll be maintained In tI1e MQD FfnanceOffiCe.
Responcfng Patricia M.Bazln.MaOHealthCareStmceeBranch
Pef8Ons: Adminl."'r
Phon.:(808) 692-8083.and AnnH KJnnlngham,MaDFInance Officer
Phone:(808)_·7966
Rat.no.200N8 rmproveControl.CMIIfUttIIdon.Fraud Accuraoyof
MedlcIidCl
Audtlol"s To elllUrecompliance.federal regulations the DHS
Recommendation: should Improve contfOllowrutIliatlon fraud and aocoracy
ofMedICaid claImsbyi1cre8slngback~nd con1nJIaetlvllles
ControlaetMttesdnfIned tomaintail\programIntegrity
needeto b&made ahigherprforily.The DHS shouldconsider theto.owing:
• Completetlte development of meanIngful SURSrepcxts and regutarty anatYze the",portaasre~lredbyTdte 42 OFRPart46U3.Theam_Isofthes reportsshOuld helpfd8ntifVexceptions or abnonnal patterns of treatment
or8eMoeand allow for the carnJCltlon of misutUlzatiOn practlcesofrecipients and provident.ftalso servesI Ian Important tooltoIdentify and IlWe8tIgatepotential
ffaUduient beI1aYIor
• Glwn 1ft,highpercentageofclaims submitted via eleClrOnic medta.ttle DHSIlbouldreil1$lilUtethe electronic med1li dalms (SMa) aOOils performedbythifdpertl £MOtu IncreaMcontrof8 overtheaccuracy Of Clldma andprovic1eian oppnnltytoinCrt provider
educationthatreduces risksofunintentional errors In futufecllims.Itmayalso serveata valuablerefen'al
souretOfpatentralfraudtotheMlU
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Trang 3• Perform regularreviews on a sample of drug and non-dnJgdall'll'paidtodetectprocessing IrrorsandIdentifY ways 10 hprowthe claimsprocessing system and procedures
• Taketimely correctiVeactiononproblemsor noncomplanee ktentllledbYlis010 such asrecowry01 owrpaymemsand implementation of recommendatfona
Ileued
• Allocate the neceaary resources neededtoactiveSy
identify andrnveeugate8UlP'!JCttdftaudasrequiredby
TIle42 CPRPart 4&5.13-CortecUve Ac1ion HPMMISmanagement reponehawbeen produced for review Takln or Planned: and bYMQD." In therec;enllyreorganized finance
Office.FlnahOfallntegtrllyStaftUnit,three nurseposillanlhave been asslgned·to regulafty enalyze ht SURSreportstolc18ntlfy excep1fons abnormalpettern8anc:lm1ldeke8 for co dIvCI
IClte MOdifiCation.totheSURS reportsatebeingmeaIS
neededwithdialogueongoingbetweentheF1l111\1Cird Integrity
8laffnul'88S and the SYstems OffIce The Systems OfticeHealth
careB .~88 ~tsalso provide the nursesonac:cuian with on4tmand provider specific repol18fortargetedUti••1Ion
re\lIlM AnewDataWarehouse componentIsbeing devetoped for HPMMl8wheellfs e""'stened 10provideusers thecapebiltyto create SURSIl1dother on-demandreports Inltilll staff
olff8ntatlon hasbeenprovided on an overview level'ut calendar year.
With"'teFebNary 2009lmplemenIMlonof tilenewQUEST ExpandecfAcceSl(QExA)managed• •PfOgr&m.the·former
- blindend dtabled fee for-atrvic& papuilltlon IsnowMrved
bytwohealth ptans TtIIs etlang& Willgreatlydlmlnleh the .for-seNfceclalmsbeingproceasedforpaymentbytheMOD,
although the SURSnu!'888continuetorevi8wfol'fraud and abuae Incldentllnthefee·tor·slllMae claimstoute.The focus of ttle SURS wlll.kntM: moveintothemanaged care arena In which.nationaRY,Integrityunitsare.Rlngtoexptore these naw roMand , ponslbIlWes Inaddition the SURS nu es are hisjllyInvolved _ theeMS MediOBId Integrity GroupadiviIte8
fnclucfngattendingnatronaleMSsponscndconferences arid trarnrng, partlciPdng in monthlY tefeconferenceswl1h other
states.and _Sling with PERM project requirements
THE OHSwl~considertile contlnued use of EMO audits to enhance provider education apportlJnltles a'S well as provide a ref8t'11l1sourceofpotential fraudtotheMIUf10 lightofthechange
ofthefee-fQr-eellVlce programintO managed care
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Trang 4End Date:
DHS willnwlew if capacfly10perfoJm.regularpostpayment reviewson samp&1p ofdrugand non-drug claimstodetect proct tngerrors and Identifyways for clajmsproceaatng system andprocedu lmprovements These reviews are also impacted
bythenew managedcareenvlronmenl
Th DHS willtakeproper ool'RlCtion actions an problems or nancomplance identifiedbyitaaro.
The MaD hu oneInve8tigalOrIVposition in IIIFfna~
Integrity Unit TheinCumbentwason lcng.tGrmsick ve for most of118 2008Cllendar year andhIlSretired! asofFebfuary 27.2009 The MQDwlibeae8ldng Govemcx'sapproval to fill ItI8pelmllUlentpOIfttontoenablethe unittohaVean actiVe Inveetigatoront1lejob The MaD VtillVKIfktoqufddyIdll'dllyand
InvesUgatesuspectedfreudU Aaqulredbyfedetal reguladcns
and c:ontlnue8toWOfkcloselywith111 AtIOmey Gen""", Medlcalcl FraudConIroIUnit(AG'&MFOU) onaUcomplaints,
The Integrity Unit has Initiated the stabllShmentofregular me.tlngswtth the AG's MFCUtoImprove eammunkldon and
promotea8IIOnl)working relationshipwiththeIrcolleagu88,
OnocH"8 Ongoing RespondingPerson: Ann H.101nlngham, MaD Flnanr:tJ OffIcer
Phone:(80$)892-7958
Ref.no lGOI-07 Comp EllglbllltyApplication and AnnUlI ElIgl.,.lfty
Fle-Vfllftleatfoneln a timely Man
AudltcH'$ '1'hecttS&IKUd _ _the&t8ffingrequirementsattine MOD Flecommendatian: E1lgl3lityBranchand make every dcrttoelIminate 1M lJaddag
ofapplClllOnl peJdt'lgeII01bilitydetermlndons and perform
timelyannual re-veriflcdans a9requiredbyfederalregulaltcns
Inordertoreduce the risk that inelgi)le reclpI are recetvlng
MedIcaidbeneft.t8
Corrective ActIOn Tt\eDHSIsworkingwith sting st8fl'toaddrentheb8ckJag1of Taken or P1anned: workat _ti unitwithapproved overtime for payor
compensatory time Off Iffort8contInuetofill all vacant positions 8SqlAckIyaspouIbiedespitethe current hiring freeze Eligibility Branchwillbesubmitlil'1ganotherliltOfvacant poIffionsfor
appravaltorecruitand fln. ElIgibility SlI'anCh completed enover~
due applieation.baClklogprojectIn September·2(1()8 through December 31, 2008 EUglbilityBfanctlcompleted an overdue EliglbUlty Renewalproject In May2<108throughJI.M2008
Branch and Oahu 8ectiIlln AdmInlstfltton continue toworkMIh unit IUplJMsorstoaddl1llll the needed improwmentv.;th
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Trang 5supetVl80ry management monItoringOftime.nessrtCIuirements and emptoye wortt pelformance8llPectaIions 'ThegoalIIto deerease theapf)f'OYOdovetIkneforpayor campeflsatory timeoff
as management, timelinesslIII'Klef11tToyeeworkperformance
ImPfCl'l'S
RtepondingPerson: AlanTakahlth~ MQD Eligib1lfty Branch Admi1l1trator
Phone: (808)587 7211
Ref.no.2OOM8 Montor MedIa8ld DrugRIItIte,
Audltor'e The DHS shOuld HtabtlSh formal procedurestomonitorits
RecOmmendation: suboontractortoInSure the ctrug ,ebate program operateain
::clIMewith CMS gufdelines andhelpidentifYIssues
• In adcltion,1he.DHS 'hOufdreconc.Dethe dRlgrebate
recllvablebalanceand outItandingrs.ues . CorrecUveAction TheMQO II worfdngtoreooncUetheofd HMSA FIscalAgent -Taken or Planned: periodofout8I8nd"IlQaccountsrecetv8bI.'eI OurcurrentFItcaI
AgentandPharmecyBentflts"-NO- ACS HealUlcare, has snipped to usCopleaof involcel,receiptsandcl\ecksreceiVed
fordrugrebate paymentsof old HMIAInvoices A totalof28 boxt8 of recards wore,eoet\fedIn our office In January 2008
OurAacaunt Clerkilpalnstakk'VYgoingthroughall ofthe
doc nttttleachboxtoldentllyand reconcilethIUpaymems
to the accourdS nK:eivableledge Todate.more IhBnhalfof the boxes havebeencompleted Withaver$100.000ofdrug
rebate$)aymemsktentIfitdtorpotting Duetothe large volume
ofdocumentsthatane clerkIsworking hough,itmay take lOnger Ihan antldpated 10 complete thfs tulie,beyond theMarch
31.2009dateldentllied earlieru an anticipated completiondate
We have 8110 had meetings with ourAttorneyGeneral',
Officeto.plst US withregaJwriteoffsofany rebate receivables
that mayremafnOnce all of the 28 boxes of dOCl.ll1.enta are reviewed andreconciledwithour oli.ltSland1ng accoul!lt$
receivable ledger '
Slart Date: Ongoing
Respondng Person: Ann H.l<lnnlnlJham MOD Fbance Offic:er
Phone: (808)692·1056
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Trang 6ReI.no.200M Malnt8in AllRequiredDaoumtlltltlon In MedIcaidPIIe8
AudftoJ"s TheCHS should ensurethat ell requr'ed documents are
Recommendation: melntar, ,WIeachc:asetiletosupporttheaIoWabllty and
_IgllllllyoftheMedcafdU8isIancepayments beIngclaimed
• federa).nlfmbuf8lll118tlL TheOHS mouldperfonncase file remws Inord8rto8SS8IIcase manager performllftCe
COrrective Action TheImparlance of pmpedy completingand filing reqUired Tl!lken01'Planned: depa!1memal focms oontinuestobe emphasiJedtoEligibility
Brarich aupeNf8Ol'8 andEMglblllyWorkers
StJpeNisory • •nMeWSwiD Include evaluation of proper documentation and cue record maintenance
Responding Person: AlanTakatlasni.MOD Eligibility Branch Admlnistrater
Phone: (808) 681·7291
t.no.2008-10 Malntafn All RMaulNd Medlcald ProvIder Documerltdon
Aucltor"s The DHS shOUld ensure d pravldef8(Je8menas areproperty Recommendation: completed and~Jled.
Corrective Action TheHeallhcare 8erYices Branchhasrevised and updatedU'le
Taken orPlanned; process for processing provider agreements Therevised
processrs asfollows:
a When provider applications are submitted to theMOO
the_lcatlOll1ls reccxded In.data_sethat1racks pnMder applicatfons ~naddllon provider eppliQatlon rlltartedIn theHPMMISsystem
b TIleappUcatlon Is tlltan forwardedtoanemployeewho
revlew$the epplcation and assurescompleten811 After
theapplca1fon 'e~wed,1110 jorItyofthe 8Pf*atiOn
Is enteredrntoHPMMlS
c PriortoenactrngtheappUc:atlori, the Data Technicfan reviewsthewItoktPfOC*8prtortosigning anet authorizfng the enactmentofthe applicatiOn After1I1e appUeatlon is
liQned,ttl.pfO\l'ldel'ItenactedIntotheHPMMISsystem
d The applrcatiOn is then recorded and sent 10 ACStor
scanning al'ld permanent flUng EachmonUt15%of.1 pl'O\lkJer applications willbereviewed to
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assuretheproc_ls etf8ctIve
" procus~Iassure1hataU necetutystepsare taken prior
10 allowfngI providertoparticipate In the MedlcafdPJOIrafn In
adcItkln.tN.process usu that Information 10 filed10that It can beretrieved88needed.
OngClCng, Ongoing RetpondtngPell'SOn: Pltricla M 8azIn, MOD HealthcareSeMces Branch
Mm5niftatot PhCne:(808) 8B2.e083
Ref.no .11 ntafftauAequiNdDooumentadonIn Child C .c.e
Fir
Auditor The DHS should ensure.requiteddocUments are mafntllnedIn
Recommendation: 8&Ghcaseflte10luppalttheallowlblliy anc:lellglbllltyoftie d'llkl
QlnIpaymenfS cratmed forfederalf8fmbul'lem8l\t.TheOtIS shauldI$JformsecandllYnM8W8on a samplebasisInorder to use casemanagerperfarmII1ce
CofrectiveAction The DHSagreeswiIh therecommendationsand willbe
Taken orPlanned!: rmpremeftllngmonthly semplerevtIwIofpayment oase records
10 verify elfglbtity compliance
Addlt!O~.priortothe endoftheCUrMmFederalFisall Year DHSwtllneedtoImplement a detailed secondarYnMeWplanof paymentcases asrequiredbytn.Improper PaymentInfomultlon Actof2002 11'11&l'8\IIewpllln,wfthapprovalbythe
AdminlltrationlotCtu1dren andFemlles(ACF) priorto inlpIImentatfon.will be • revIewofpayment"cordi fortile
current federal fitealyear.
The DHS has recenUy blishedfilloffice the Chlrd care Program0flIc:e(00'0)wlthfn the Benefit, Employmentand
Support 8enlicesOMslon (BESSO).that\\1U specifically focus on
Ohlldoareand wlibetheoffiCeresponslble for implementatiOn
of thesecondarymi8W$ The OHS Isconfidentthere win be greater m•.,.gernent and oversightoftne ChIld care Payment program thraugh this reorganizationeffort
StartDate: April 2009
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Trang 8RespondIng Person: Julie Morita BESSO OCP Adminl8tf'ator
Phone(808)588-7012
~.no "'12
Auditor's
Recommendation:
Con'ecIwe AcIiotl
Taken or Planned:
Stall'tDate:
EndDate:
A8sponditg Person:
ImIJ"'Oft AGoura.,of ChIld care R.lmbul'Mt'ne" TheDHS Shcurd'., that reknbUl$9RlsnIStochlkl care program partclplnts are calculated pmperty.TheOHS should pedon'npost
~revIewa of.sampleofchUu .paymentstoensure accuracyand _ _caseWOlt<erp8ffOm1anC8.
TheDHSIgfHIwith"".recammendatfonsandwitlbe
Implementingmonthly tample ofpayment cue reGords ,toverify eligibilitycornpllenCe
AddIIonally.priortothenoftheQJI'f8I1tFederalFlecalVear DHS willn,"toimplement adetailedsecondaryrevieWplanof
payment .e requfredbythe Improper Payment Information
Actof2002 Thill9Jiewpfan.withapprMJbytI18
AdmlnJatlallanforChlclren and F ,11e8 (ACF)priorto
ImpllttMntalion Wlibeareview'ofpaymentrec0td8 for tne cunentfedenllfiscal year
TheOMS_recentlyestablishedanoffice.theChId cere Program OIflce(CCPO)wtlhln the Benefit, Employment and SUpport Servtces DIvIsion (8ESSO) that will~eemC8UyfocUSon Chtldcareand willbethe officerespon81b1eforimplemelltalloo
orthe secondlU'Yrevtews TtIeDHSIsQORfldenttherewillbe
greatermanagementand oversightoftt1&cttUdcare Payment program through this reDrglnfzdoneffort
Aprl2009
Ongoing
Jun Morita BESSO COPAdministrator
Phone (808) 58&01072
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