Examinations – Fiscal Year Ended June 30, 2020

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Executive Summary

Background

The Delaware Office of Auditor of Accounts presents twelve examinations of Long-Term Care Facility fiscal records of the State of Delaware Department of Health and Social Services (DHSS), Division of Medicaid and Medical Assistance, Medicaid Long-Term Care Facilities’ Statement of Reimbursement Costs for Skilled and Intermediate Care Nursing Facilities – Title XIX and Nursing Wage Survey (cost report and nursing wage survey, respectively) for fiscal year ended June 30, 2020. 

The State Auditor is authorized under 29 Del. C. §2906 to conduct post-audits of all financial transactions of all state agencies. 

These engagements were conducted in accordance with federal requirements (42 CFR 447.253 and 483 Subpart B) and state requirements (Title XIX Delaware Medicaid State Plan, Attachment 4.19D) (criteria), as applicable to the Long-Term Care Facility fiscal records. The criteria were used to prepare the Schedule of Adjustments to the Trial Balance, Patient Days, and Nursing Wage Survey for fiscal year ended June 30, 2020, found in the reports.

Key Information and Findings

Of the twelve (12) long-term care facilities examined, eleven (11) of these facilities received unmodified opinions and complied, in all material respects, with the criteria mentioned above. 

All facilities audited did have adjustment or comment findings in the reports. Management of eight (8) facilities provided no response or corrective actions to the auditor’s findings.

Common findings and adjustments included:

• Improper calculation of patient days on the cost report
• Grouping expenses to improper cost centers
• Variances between Medicaid, Medicare, and Other payer types
• Self-insurance funds not setup through an independent fiduciary
• Inclusion of non-allowable expenses with reimbursable costs

One long-term care facility examined, Parkview Nursing and Rehab, received a qualified opinion and eight findings, one of which resulted in both a material weakness in internal control and a compliance finding. The facility was unable to provide general ledger and supporting documentation for the period, resulting in $7.7 million (60.4%) untested costs. The remaining seven (7) findings include five (5) adjustments to the Trial Balance, Patient Days, or Nursing Survey Report and two comments.

Full Audit Reports

Unqualified Opinions:

• Cadia Rehabilitation Renaissance
• Cadia Rehabilitation Silverside
• Complete Care at Brackenville
• Complete Care at Silver Lake
• Courtland Manor
• Exceptional Care for Children
• Milford Center
• Pinnacle Rehabilitation and Care Center
• Regency Healthcare and Rehabilitation Center
• Stockley Center
• Willow Brooke Court at Manor House

Qualified Opinion:

• Parkview Nursing and Rehabilitation