Follow-up assessment of a previously audited provider finds issues remain

Recently, OIG auditors revisited a substance use disorder treatment provider audited initially in 2021.

The Cenikor Foundation is a substance use disorder treatment provider contracted by Texas Health and Human Services to provide eligible Texans with substance abuse rehabilitation. The foundation's operations are divided into regions throughout the state, with several regions audited separately in 2021.

The follow-up audit was conducted to determine if Region 7, an area that runs from Waco to San Marcos, had addressed four categories of issues using recommendations provided in 2021.

Of the 13 recommendations made in the original audit, auditors determined that Cenikor had not completed the implementation of all recommendations for three out of four issues.

Issue one in the original audit detailed that Cenikor did not consistently provide evidence that it delivered the required monitoring and counseling services. In the follow-up audit, 11 out of 12 tested admissions did not meet the requirement.

Issue two asserted that Cenikor did not provide evidence that it consistently met program and contractual requirements in the 2021 audit. The follow-up showed Cenikor failed to meet medical, clinical, consent and discharge requirements for all patients. Specifically, the foundation did not:

• Meet all medical requirements by failing to perform a required face-to-face examination within 24 hours of admission for one of the four tested residential detoxification clients and not documenting three of eight tested health assessments in CMBHS.
• Meet nine clinical requirements for all applicable clients. Of the nine requirements, five failed to be performed more than 30% of the time.
• Always record the client's consent to treatment, including signatures and dates from both staff and client.
• Always provide clients with referrals for additional services and document the reason for unsuccessful follow-up visits in the CMBHS.

Auditors found that all recommendations in issue three from the previous audit had been implemented.

Issue four, detailed in the previous audit, stated that Cenikor had not ensured staff met training, educational and supervision requirements. Specifically:

• Nine of 11 reviewed staff members did not complete co-occurring psychiatric and substance use disorder training.
• One of four direct care staff did not complete trauma-informed care and cultural competency training within the required timeframe.
• Cenikor did not provide documentation showing proper supervision for two of the four counselor interns.
• Two out of three supervising counselors had failed to obtain the required continuing education in clinical supervision. Auditors issued recommendations for the foundation to implement.

Upon completing the audit, recommendations were issued on how the foundation could come into compliance with all outstanding issues.