REPORT ON THE RATE SETTING AUDIT

Transcription

1 REPORT ON THE RATE SETTING AUDIT MATHARU SISTED LIVING, INC #3 GARDENA, CALIFORNIA PROVIDER NUMBER: LTC60897F NATIONAL PROVIDER IDENTIFIER: FISCAL PERIOD ENDED DECEMBER 31, 2009 Audits Section - Gardena Financial Audits Branch Audits and Investigations Department of Health Care Services Section Chief: Maria Delgado Audit Supervisor: Cyrus Lam Auditor: Ching Chen

2 State of California Health and Human Services Agency Department of Health Care Services DAVID MAXWELL-JOLLY Director ARNOLD SCHWARZENEGGER Governor December 3, 2010 David Matharu, Administrator Matharu Assisted Living, Inc. # West 156 th Street Gardena, CA MATHARU SISTED LIVING, INC. #3 PROVIDER NUMBER: LTC60897F NATIONAL PROVIDER IDENTIFIER: FISCAL PERIOD ENDED: DECEMBER 31, 2009 We have examined the facility's financial records/medi-cal Cost Report for the above-referenced fiscal period. Our examination was made under the authority of Section of the Welfare and Institutions Code and, accordingly, included such tests of the accounting records and such other auditing procedures as we considered necessary in the circumstances. In our opinion, the data presented in the accompanying audit report schedules represent a proper determination of the allowable costs and patient days for the above fiscal period in accordance with Medi-Cal reimbursement principles. The results of our examination are as follows: COST AND COST PER DAY COST COST PER DAY Reported Cost/Cost Per Day $ 367,562 $ Net Audit Adjustment (2,648) (1.21) Audited Cost/Cost Per Day $ 364,914 $ This audit report includes the: 1. Audit Report Schedules 1 and 2 2. Audit Adjustments Schedule Future Medi-Cal long-term care prospective rates may be affected by this examination. The extent to which the rates change will be determined by the Department's Rate Development Branch. Financial Audits/Gardena/A & I, MS 2103, South Hamilton Avenue, Suite 280, Gardena, CA Telephone: (310) / FAX: (310) Internet Address:

3 David Matharu Page 2 Notwithstanding this audit report, overpayments to the provider are subject to recovery pursuant to Section , Article 6 of Division 3, Title 22, California Code of Regulations. If you disagree with the decision of the Department, you may appeal by writing to: Chief Department of Health Care Services Office of Administrative Hearings and Appeals 1029 J Street, Suite 200 Sacramento, CA (916) The written notice of disagreement must be received by the Department within 60 calendar days from the day you receive this letter. A copy of this notice should be sent to: United States Postal Service (USPS) Courier (UPS, FedEx, etc.) Assistant Chief Counsel Assistant Chief Counsel Department of Health Care Services Department of Health Care Services Office of Legal Services Office of Legal Services MS 0010 MS 0010 PO Box Capitol Avenue, Suite Sacramento, CA Sacramento, CA (916) The procedures that govern an appeal are contained in Welfare and Institutions Code, Section 14171, and California Code of Regulations, Title 22, Section 51016, et seq. If you have questions regarding this report, you may call the Audits Section Gardena at (310) Original Signed By: Maria Delgado, Chief Audits Section Gardena Financial Audits Branch Enclosure Certified

4 STATE OF CALIFORNIA DDH/DDN SCHEDULE 1 SUMMARY OF AUDITED FACILITY CENSUS AND AUDITED CLIENT COST PER DAY Provider: Fiscal Period: MATHARU SISTED LIVING, INC. #3 JANUARY 1, 2009 THROUGH DECEMBER 31, 2009 Provider Number: Provider NPI: LTC60897F SUMMARY OF AUDITED FACILITY CENSUS AND AUDITED CLIENT COST PER DAY REPORTED AUDITED 1. Medi-Cal Client Days (Adj ) 2,182 2, Other Client Days (Adj ) 0 3. Total Client Days 2,182 2, Total Client Care Expenses (From Sch. 2) $ 367,562 $ 364, AVERAGE CLIENT COST PER DAY (Line 4 / Line 3) $ $ SHARE OF COST 1. Share of Cost Audit Adjustment (Adj ) $ NA $ 0 OVERPAYMENTS 1. Duplicate Payments (Adj ) $ $ 0 2. Credit Balances (Adj ) $ $ 0 3. Total Overpayments $ 0 $ 0

5 STATE OF CALIFORNIA DDH/DDN SCHEDULE 2 SUMMARY OF AUDITED FACILITY EXPENSES Provider: Fiscal Period: MATHARU SISTED LIVING, INC. #3 JANUARY 1, 2009 THROUGH DECEMBER 31, 2009 Provider Number: NPI: LTC60897F Line ADJ AUDIT No. DESCRIPTION NO. REPORTED ADJUSTMENT AUDITED EXPENSES: CLIENT SERVICES Basic Facility Cost - Property Expenses 045 Depreciation and Amortization $ 5,589 $ $ 5, Leases and Rentals Real Property Taxes 1 3, , Personal Property Taxes Mortgage Interest 2 7,244 (2,330) 4, Property Insurance TOTAL PROPERTY EXPENSES (Lines 045 through 070) $ 17,159 $ (2,243) $ 14,916 Basic Facility Cost - General Home Expenses 080 Home Operations and Maintenance 3 $ 10,477 $ (114) $ 10, Utilities 4,511 4, Client Transportation 4 6,677 (291) 6, Dietary 16,797 16, Personal Care and Laundry 9,515 9, TOTAL GENERAL HOME EXPENSES (Lines 080 through 100) $ 47,977 $ (405) $ 47, TOTAL BIC FACILITY COST (Lines 075 plus 105) $ 65,136 $ (2,648) $ 62,488 EXPENSES: DIRECT CARE STAFF COSTS 115 QMRP Salaries $ 16,940 $ $ 16, QMRP Fringe Benefits Lead Salaries 37,118 37, Lead Fringe Benefits 4,636 4, Aides Salaries 113, , Aides Fringe Benefits 16,187 16, Other Salaries Other Fringe Benefits TOTAL DIRECT CARE STAFF COSTS (Lines 115 through 150) $ 188,035 $ 0 $ 188,035 Page 1 of 2

6 STATE OF CALIFORNIA DDH/DDN SCHEDULE 2 SUMMARY OF AUDITED FACILITY EXPENSES Provider: Fiscal Period: MATHARU SISTED LIVING, INC. #3 JANUARY 1, 2009 THROUGH DECEMBER 31, 2009 Provider Number: NPI: LTC60897F Line ADJ No. DESCRIPTION NO. AUDIT REPORTED ADJUSTMENT AUDITED EXPENSES: CONSULTANT COSTS 160 Dietician Consultant $ 300 $ $ Speech Pathology Consultant 1,525 1, Physical Therapy Consultant 2,640 2, Occupational Therapy Consultant Pharmacist Consultant Nurse Consultant 13,990 13, Psychologist Consultant 1,705 1, Physician Consultant Recreational Consultant Social Service Consultant Other Consultant TOTAL CONSULTANT COST (Lines 160 through 210) $ 21,389 $ 0 $ 21,389 EXPENSES: ADMINISTRATIVE COSTS 220 Administrative Salaries $ $ $ Administrative Fringe Benefits Quality Assurance Fees 13,865 13, Other Administrative and General 79,137 79, TOTAL ADMINISTRATIVE COST (Lines 220 through 230) $ 93,002 $ 0 $ 93,002 TOTAL COSTS RELATED TO CLIENT CARE (Lines 110, 155, 215 and 235) $ 367,562 $ (2,648) $ 364,914 (To Sch. 1) (To Sch. 1) NON-CLIENT CARE EXPENSES 240 Non-Program Services $ $ $ TOTAL FACILITY EXPENSES (Lines 110, 155, 215, 235 and 240) $ 367,562 $ (2,648) $ 364,914 Page 2 of 2

7 State of California Department of Health Care Services Provider Name Fiscal Period Provider Number MATHARU SISTED LIVING, INC. #3 JANUARY 1, 2009 THROUGH DECEMBER 31, 2009 LTC60897F Report References COST REPORT AUDIT REPORT Adjustments 4 DHS3076 Adj. Page or As Increase As No. Exhibit Line Col. Sch Line Explanation of Audit Adjustments Reported (Decrease) Adjusted ADJUSTMENTS TO REPORTED COSTS Real Property Taxes $3,885 $87 $3,972 To adjust property tax expense to agree with the provider's records Mortgage Interest $7,244 ($2,330) $4,914 To reconcile the reported mortgage interest expense to agree with the provider's records Home Operations and Maintenance $10,477 ($114) $10,363 To reconcile the home operations and maintenance expense for proper cost determination Client Transportation $6,677 ($291) $6,386 To adjust client transportation expense for proper cost determination. Page 1