Scope of audit limited to Muscogee County Jail Clinic
Payroll Issues & Overtime
Medical Records Review
Third-Party Provider Contract for Emergency Care
Budgetary Performance & Backlog of Unpaid Jail Clinic Invoices
POLICIES & PROCEDURES- ISSUE/CONCERN:
Clinic Service Administrator, Paul Morris working to re-develop Policies & Procedures, noting earlier ones were discarded during his absence
Most communication and directives to staff by word-of-mouth, without specificity of expected outcomes
Lack of definition as to skill level/training required to perform certain operational functions
POLICIES & PROCEDURES- RECOMMENDATIIONS:
Follow-up evaluation of Policies & Procedures by Auditor after development /Staff Training by CHC
POLICIES & PROCEDURES- MANAGEMENT RESPONSE:
CHC to develop, implement, & train staff on their Policies and Procedures that are used nationwide in their clinics, eliminating ambiguity on Policies and Procedures
PAYROLL RECORDS OVERTIME ISSUES:
Payroll vs. budget
Payroll calculations were verified to be correct based on the hours reported and current pay rates
Payroll was distributed by auditor to all payees, ensuring that the employees exist
Clinic staffing vacancies & absences frequently resulted in the use of staff overtime and contract labor usage to cover staffing needs
Overtime hours were excessive, with some employees overtime earnings representing a substantial portion of their total earnings
As a result of overtime & contract labor, the clinic payroll budget was routinely exceeded
Efforts need to be made to improve scheduling so that overtime is not built into the work schedules of employees; overtime should only be used for unforeseen emergencies
The privatizing process showed that the clinic was inadequately staffed, often leading to overtime
Salary is a fixed component of the contract with CHC
CHC will implement their nationwide policies & procedure for handling payroll
MEDICAL RECORDS REVIEW- ISSUES:
Inaccurate or incomplete medical records
Do medical records reflect medial examinations, medical testing, treatments and medications dispensed to in-mates?
MEDICAL RECORDS REVIEW-FINDINGS:
Medical Record charts of inmates reflected a variety of medical exams, testing, treatments and medications dispensed, indicating reasonable documentation accuracy and completeness
The Medical Intake Screening Forms did not include the results of several PPD Tests and some height and weight measurements were unrecorded
Medical intake screeners consisted of persons employed as Medical Technicians, Licensed Practical Nurses and Registered Nurses
MEDICAL RECORDS REVIEW- RECOMMENDATINOS
It is recommended that all intake screenings be reviewed by a Registered Nurse, Physician, or Physician Extender as soon as practicable after the screening occurs, to assess the need appropriate medical care.
MEDICAL RECORDS REVIEW – MANAGEMENT RESPONSE:
THIRD PARTY PROVIDER CONTRACTS FOR EMERGENCY CARE – ISSUE:___________________________________________________________
Emergency Care for inmates/prisoners at the Jail and Prison is provided by The Medical Center-Midtown, partially funded by a $500,000 allowance from the Indigent Care Funding provided by the City to cover the cost of indigent care for the community. This allowance is part of the 30-year contract executed by the parties in 1992.
CONTRACTED EMERGENCY CARE – FINDINGS:
For the past three years, these additional amounts billed were: 2012- $822,063; 2011 - $623,412; 2010 - $852,944, according to a recent audit of the Indigent Care Contract
EMERGENC Y CARE CONTRACT – RECOMMENDATIONS:
It is recommended that the $500,000 emergency care allowance be apportioned between the Jail and the Prison, based on actual charges for the past 3 -5 years, and those amounts be included in their respective budgets, and future overages paid by the each entity, encouraging each to control their use of emergency care
CONTRACTED EMERGENCY CARE – MANAGEMENT RESPONSE:
Due to lack of specific case information, I am unable to address this issue regarding inmates sent out at the end of shift/upon arrival at jail. H.S.A. Morris has been successful at ensuring that the City only pays for services rendered. He investigates any abnormally high uses of emergency care. The Office will work with CHC to monitor inmates transfers to the ER
BUDGETARY PERFORMANCE – ISSUE:
Does the Jail Clinic provide required inmate medical care to its inmates?
Is the care provided in a cost efficient manner?
BUDGETARY PERFORMANCE – FINDINGS:
The Jail Clinic provides a way array of services to its inmates, at the clinic site and by non-clinic providers. Medical, Dental, Vision, Medication Dispensing, Sick Call and Mental Health Services are performed within the Jail/Clinic. Emergency Care, Surgery, Dialysis, and Other Specialty Care is normally provided by outside providers
At the end of FY2013, a sizable backlog of unpaid Jail Clinic bills existed. It took an extended period of time to ascertain the dollar volume ($900,000+) and expense categories of these unrecorded liabilities. While the backlog may be due to extenuating circumstances, such is wrought with problems:
Management was unaware of their current budgetary performance, which can undermine credibility
FY2014 budget for the Jail Clinic without a reasonable projection of current year expenses to serve as a base for the upcoming year’s budget
It potentially delayed the completion of the external auditor’s field work, which may cause an increased cost for the audit
BUDGETARY PERFORMANCE – RECOMMENDATIONS:
Require vendors to provide detailed invoices including item, quantity, size/dosage, and the unit price and extended price of each line item.
Perform regular inventories of items such as pharmaceuticals, which are highly marketable inside and outside of the facility.
Assign personnel to tasks for which they are fully qualified. State and Federal Regulations provide guidance in this area.
Prcess invoices, payroll and other cost items in a timely fashion, to allow management to review and act on budgetary and performance measures before such becomes unmanageable.
Employ a person, within the Sheriff’s Office, that is trained, skilled an experienced in the preparation of budgets, performing financial and operational analysis, and controlling expenses to budgeted levels.
Employ or contract management skilled in managing all critical aspects of jail clinic operations.
BUDGETARY PERFORMANCE – MANAGEMENT RESPONSE:
FINAL RESPONSES OF SHERIFF DARR: