1. DEPARTMENT OF HEALTH CARE SERVICES
Audits & Investigations –
Financial Audits Branch
Presented by:
Gary Diffenderffer, CIA
Health Program Audit Manager

2. Introduction: Financial Audits Branch (FAB) Cost Report Process:
Submission
Acceptance
Approval
Results of Acceptance/Approval Process
Audit Issues

3. Financial Audits Branch (FAB)
Responsible for providing program integrity of healthcare programs administered by the California Department of Health Care Services
Performs financial audits of Medi-Cal Providers (includes TCM) to ensure compliance with applicable laws, regulations, and program intent.

4. Cost Report Flow: Submission of Cost Report
Acceptance Acceptance Letter
Approval Approval Letter
Begin Invoicing
TCM Program

5. TCM Cost Reports - Submission
TCM Cost Reports due November 1st
Hard Copy Audit Review and Analysis Section
(ARAS)
Soft Copy
(Audits Section – Sacramento)

6. TCM Cost Reports - Submission
Hard Copy* – Includes, but not limited to the following:
Cover Letter
Certification Statement
Cost Report (Signed) / Including Funding Schedule
Time Survey Template
List Worksheet
Totals Worksheet
Time Sheets
Cost Report Review Tool
Supporting Documentation
*Refer to TCM Cost Report Instructions

7. TCM Cost Reports - Submission
Soft Copy – Includes the following completed items:
Cost Report Template
Survey Template
List Worksheet
Totals Worksheet
Time Sheets
Funding Schedule
Cost Report Review Tool Template

8. TCM Cost Reports - Acceptance
Acceptance Process :
Responsibility of ARAS:
Completion of five page checklist:
Reconcile reported amounts on “hard copy” to “soft copy” of the filed TCM cost report
Hard Copy Soft Copy
Ensure cost report is “complete” in accordance with the current TCM Cost Report Instructions

9. TCM Cost Reports - Acceptance
Acceptance Process:
Contact designated LGA Coordinator for missing and/or incorrect items.
Via
Hello TCM Coordinator:
Please send the requested information
via within the next 24 hours.
Thanks,
ARAS

10. TCM Cost Reports - Acceptance
Acceptance Process :
Acceptance Letter issued by ARAS
Acceptance Letter LGA
For each TCM Cost Report (LGA and CBO)
Identifies “postmark date” to establish 36-month audit period
Letter issued to LGA only. CBOs do not receive a letter.

11. TCM Cost Reports - Acceptance
Top reasons cost report was not accepted upon first review:
Did not include “TCM encounters by month”
IRS Form 990 not included
Electronic copy of Worksheet A did not match hard copy
Complete Table of Contents not included
Financial statements for CBO not included
Electronic copy of Cost Report not submitted

12. TCM Cost Reports - Approval
Approval Process :
Responsibility of Audits Section - Sacramento
Review of checklist completed by ARAS
Identification of “potential” audit issues for future audits
Issuance of Approval Letter

13. TCM Cost Reports - Approval
Approval Process :
Approval Letter issued by Audits Section – Sacramento
Approval Letter
One letter issued for each target population served by an LGA
Purpose of the letter is to establish:
TCM Rate Period (2008/2009)
Rate Per TCM Encounter
TCM Maximum Amount

14. TCM Cost Reports - Approval
Approval Process :
(Excerpt from an Approval Letter)
TCM Program Type (06): Public Health
Rate Per TCM TCM Rate Period TCM Encounter Maximum Amount
FY $ $100,220.00
400 encounters $ x 400 = $100,220

15. TCM Cost Reports - Approval
Approval Process :
Approval Letter issued by Audits Section – Sacramento
LGA
Approval Letter
TCM Program*
*The Approval Letter authorizes the TCM Program to accept an LGA’s invoice(s), and establishes, both, the approved rate per encounter and maximum amount.

16. TCM Cost Reports – 2007-2008 Results
Month Approvals
Current Yr Prior Yr
Nov
Dec
Jan
Feb
Mar
Apr
May
Totals * *
*Reflects LGA “Approved” SPA Cost Reports; excludes CBO cost reports.

17. Audit Issues: Amended Cost Reports Denied Cost Reports Audits:
Payments
Audits In Process:
Certified Public Expenditure
Status
Future Audits:
Desk
Field

18. Questions?

19. FAB Contact Information
Audit Review & Analysis Section (ARAS)
Gary Wong, Chief
(916)
Audits Section - Sacramento
Gary Diffenderffer, Supervisor
(916)

20. DEPARTMENT OF HEALTH CARE SERVICES
Audits & Investigations –
Financial Audits Branch
Presented by:
Gary Diffenderffer, CIA
Health Program Audit Manager