OIG audits Home and Community Support Services Agency in Pasadena
Recently, the OIG audited Elara Caring, a Home and Community Support Services Agency, finding the provider complied with most program requirements, including developing Individual Service Plans (ISP) for clients. Auditors, however, did determine that the Pasadena-based facility failed to meet certain maintenance requirements for the Electronic Visit Verification (EVV) system and did not complete all background checks before the staff came into contact with clients.
HCSSA providers work in local communities to deliver medical and self-care services to Medicaid clients. Elara Caring provides behavioral home health, hospice care, personal assistance services, and skilled home health services. To address the individual needs of each Medicaid client, providers must develop ISPs that account for the needs of the individual. The OIG audit team reviewed a sample of 45 client records and discovered all plans were properly developed for scope, duration and frequency and signed by the client. Further review revealed that the EVV systems data matched the frequency and duration for each of the reviewed client's ISP.
The EVV system records the amount of time a provider spends with a client allowing Texas Medicaid to verify that the program is only paying for delivered services. At times the EVV does not collect all necessary data at the time of service and providers must perform visit maintenance to update these records. Elara Caring did not consistently perform this required maintenance leaving OIG auditors unable to verify some information related to the delivery of Medicaid services. In total 94 out of 15,569 reviewed transactions could not be verified due to a lack of supporting documentation resulting in an overpayment of $5,121. Auditors recommended the provider needed to improve controls related to the EVV system and repay the state $5,121 for the unverifiable hours.
The OIG also reviewed staffing procedures to protect clients' safety. Auditors found that Elara Caring had performed new-client orientations for all thirty attendants included in a sample of employees whose records were reviewed. Additionally, all thirty attendants had undergone mandatory background checks for criminal records. Of the sampled employees, one was found to have been in face-to-face contact with a client prior to the completion of these background checks. OIG auditors recommended the agency complete all required background checks as detailed in program requirements.
Elara Caring management agreed with all recommendations and has implemented courses of action prior to the publication of the audit.