Providers of in-home support for the elderly and developmentally disabled are appealing financial audits that seek to recover $4.2 million in overpayments and fines from their businesses.
Supported Living Network consultant Bruce Blaney said auditors are citing violations where none exist.
The Baton Rouge group includes businesses and family members who advocate for in-home help to keep people out of nursing homes and other institutions.
Blaney calls the audit results “a fabrication of fraud” that’s part of a Jindal administration assault on the industry.
“Eighty to 90 percent of those findings are invalid,” he said.
Blaney said the same level of scrutiny is not being placed on nursing homes and groups homes that provide institutional care for the same population.
At issue are audits done by the certified public accounting firm of Postlethwaite and Netterville on the 41 highest paid businesses out of 1,928 firms that provide in-home support. Forty of the firms have appealed the findings.
The companies participate in Medicaid, the government health insurance program for the poor.
Meanwhile, Department of Health and Hospitals Undersecretary Jerry Phillips said Tuesday that the targeted audits followed a series of reports by the legislative auditor that found “huge error rates” in billings over years.
He said businesses will be given a chance to demonstrate that their billings are correct and they are meeting program guidelines before sanctions are enforced.
For the most part, program integrity chief Kimberly Sullivan said the audit problems are related to documentation issues — “just sloppy documentation.”
Sullivan said only one case has been referred to the state attorney general’s office for suspected fraud.
Those facing sanctions contend that DHH and auditors have been sloppy in doing the assessments as well as keeping up with records.
A majority of the citations are for not having updated plans of care for clients even though DHH had notified providers that the existing plans were being extended, said Jacquelyn Blaney, executive director of Independent Living Inc. There was no requirement for new plans to be in the file, she said.
“It’s shock and awe when you get a letter for over $150,000 and your (company) check from the state is $50,000 a month,” said Blaney, who said most of her audit problems related to updated care plans.
Sullivan acknowledged the mistake. She said her office had not been aware that two other DHH agencies had stopped the development of new care plans as a dispute arose over cutting back allowable hours.
She said she did not know how many of the citations related to the care plan issue.
Darlene St. Romaine, owner of Sylvia’s of Bunkie, with about 290 clients, said the requirement for doing background checks on workers is also being misapplied, leading to erroneous citations.
The auditors apparently were not aware of rules that allow hiring of an individual as long as they are supervised until the background check can be completed, she said.
Sullivan said auditors did know about the rule and found reason to cite firms.
Stella Wiltz, owner of Activities of Daily Living, with 175 clients, complained that billing discrepancies of an hour led to the denial of all the care hours claimed.
Wiltz expressed frustration at having to undergo another round of appeals, noting that she just got through fighting $112,000 in citations which were reduced to $1,700.