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Enhancing Safety and Reducing Payment Errors in the Supported Living Program

This report outlines an audit of the Supported Living Program, which serves approximately 3,700 vulnerable adults and incurs costs exceeding $280 million annually. The audit reveals a staggering 6% in improper payments that highlight issues such as data entry errors and unsupported payments, amounting to $11.3 million. Safety concerns arise from caregivers' backgrounds and inadequate training. The report recommends implementing a robust electronic payment approval process and improving monitoring to ensure safety and accountability in service delivery to clients.

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Enhancing Safety and Reducing Payment Errors in the Supported Living Program

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  1. Preventing Payment Errors & Improving Safety in the Supported Living ProgramJoint Legislative Audit and Review CommitteeAugust 14, 2013David Dean, Deputy Director of Performance AuditSohara Monaghan, Performance Auditor

  2. Background Supported Living Program • Over $280 million spent and about 3,700 clients served in FY12 • Provides up to 24 hours of daily support to vulnerable adults with basic activities such as taking medications, preparing meals, etc. Why did we do this audit? • Audits of similar programs indicated high risk for improper payments • High cost program • Not independently audited for improper payments

  3. Audit question Did the Developmental Disabilities Administration make improper payments to businesses providing supported living services?

  4. What are improper payments? Incorrect payments: • Overpayments and underpayments • Payments for services not provided Questionable payments: • Payments not supported with adequate documentation • Payments made to ineligible businesses and caregivers Our audit looked for improper payments in all categories.

  5. What we found 6% in improper payments Client safety concerns

  6. Data entry errors resulted in overpayments Administration paid an estimated $500,000 in overpayments Transfer of payment rates prior to June 2013-Manual data entry

  7. Complex, paper-based process led to unauthorized payments Administration paid an estimated $5.5 million in unauthorized payments Rate approval process prior to June 2013 - Paper based 45% lacked required reviews

  8. New automated rate approval process will prevent errors If followed properly, the new automated process: • Should eliminate overpayments resulting from data entry errors • Should help ensure rates are properly reviewed and approved for payment

  9. No process in place to ensure payments are supported The administration paid an estimated $11.3 in unsupported payments • The administration currently does not have a process in place to ensure that monthly payments are adequately supported with payroll records • Insufficient documentation indicates a risk that businesses were paid for services not provided to clients

  10. Caregivers with failed background checks hired • Current monitoring process occurs every two years, is random, and reviews only 10% of a business’ employees Reviewed about 1500 caregivers’ background check results Found 23 caregivers with disqualifying offenses (assault, felony, theft, malicious mischief, drug charges, abuse and neglect…)

  11. Caregivers lacked safety training • At least 12% of caregivers in our sample may not have completed critical safety training such as: • First aid and CPR • Blood borne pathogens with AIDS/HIV • Mandatory reporting requirements for abuse and neglect • Current monitoring process occurs every two years, is random, and reviews only 10% of a business’ employees

  12. Improvements resulting from Initiative 1163 2011 2013 2016 The Administration is developing tools to track compliance with I-1163 requirements and hold businesses accountable Voters approved I-1163 expanded training, background checks and certification requirements for long-term care workers Supported living caregivers must meet I-1163 requirements

  13. Recommendations To prevent overpayments, we recommend the administration ensure staff: • Follow the new electronic rate approval process • Update client payment rates promptly and close old payment authorizations • Review the new duplicate payment report and take actions to stop and recover overpayments To ensure payments to businesses are adequately supported, we recommend the administration: • Create a procedure for reconciling payments to businesses’ payroll records, to ensure they support invoices for payments To protect client safety, we recommend the administration: • As part of the business two-year recertification inspections, ask residential care inspectors to check business’ employment records against a report of caregivers with disqualifying background checks

  14. Contact Information • Sohara Monaghan • Performance Auditor • (360) 725-9718 • Sohara.Monaghan@sao.wa.gov Website:www.sao.wa.gov

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