A P ERFORMANCE A UDIT OF T HE D IVISION OF R EHABILITATION S ERVICES C OST C ONTROLS Office of the Utah State Auditor 1
Mission Statement We provide Utah taxpayers and government officials with an independent assessment of financial operation, statutory compliance, and performance management for state and local government. Office of the Utah State Auditor 2
Controls Reviewed • Vehicle Modifications • Direct Authorizations • Medical Expenditures • Identity Verification Office of the Utah State Auditor 3
Background • DRS Established in 1921 • Assists Disabled Clients Obtain/Retain Employment •VR Disability = “Substantial Impediment to Employment” • Reports to the State Board of Education Office of the Utah State Auditor 4
Background $35,000,000 $30,000,000 $25,000,000 $20,000,000 Administrative Costs $15,000,000 Program Costs $10,000,000 $5,000,000 $- Office of the Utah State Auditor 5
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 Office of the Utah State Auditor 6
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 Office of the Utah State Auditor 7
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 Office of the Utah State Auditor 8
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 Office of the Utah State Auditor 9
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 Office of the Utah State Auditor 10
Finding 2 : Noncompliance with Direct Authorization Policy Increases Fraud Risks October 2010 June 2011 February 2012 May 2012 Tires and gas for Tires for Gas for Gas for Car A Car C Car B Car C September 2012 March Licensing, 2012 inspection, and August 2010 January 2011 December 2011 insurance for Tires for Gas for Car A Gas for Car A Gas for Car B Car C Car C 2011 2012 2010 September 2010 November 2011 August 2012 Gas for Car C Gas for Car A Gas for Car B and licensing for Car A January & April 2012 November – October 2012 – June 2013 December 2010 Gas for Car B and Gas for Car C Tires, inspection, gas for Car C and licensing for Car A and gas for Office of the Car B Utah State Auditor 11
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 Office of the Utah State Auditor 12
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 Office of the Utah State Auditor 13
Finding 3 : The DRS Could Reduce Costs and Improve Controls by Contracting Medical Functions Utah Medicaid Percent CPT Code Procedure DRS Rate Rate Difference (Traditional) 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% Office of the Utah State Auditor 14
Finding 3 : The DRS Could Reduce Costs and Improve Controls by Contracting Medical Functions Utah Medicaid Utah Medicaid CPT Code Procedure DRS Rate Rate Rate (Primary (Traditional) Care Network) Psychiatric 90801 $200.10 Discontinued Discontinued Exam 90805 Psychotherapy $92.00 Discontinued Discontinued Pharmacologic 90862 $73.14 Discontinued Discontinued Management Interactive 90802 $212.52 Discontinued Discontinued Psych Interview Office of the Utah State Auditor 15
Finding 3 Recommendations • Contract with Medicaid to Process Medical Claims and Access Medical Consultants • Adopt and Use the Medicaid Fee Schedule Office of the Utah State Auditor 16
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 Office of the Utah State Auditor 17
Finding 4 : Identity Verification Could Support Client Employment and Reduce Potential Fraud Requires Verifies Identity Does Not Verify State Identification as a Best Practice Client Identity Documents Arizona X Colorado X Idaho X Nevada X New Mexico X Utah X Wyoming X Office of the Utah State Auditor 18
Finding 4 Recommendation Ensure that DRS Clients have Adequate ID to Verify Identity Required to Obtain Employment Office of the Utah State Auditor 19
Recommendation We recommend that the Legislature evaluate the current organizational alignment and reporting structure for the state's vocational rehabilitation program to ensure appropriate oversight and mission alignment. Office of the Utah State Auditor 20
Q UESTIONS ? AUDITOR.UTAH.GOV Office of the Utah State Auditor 21
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