REPORT ON THE RATE SETTING AUDIT MACLAY HEALTHCARE CENTER SYLMAR_part4 pdf

State of California Department of Health Care Services Provider Name Fiscal Period Provider Number 30 MC530 Adj. Page or As Increase As No. Exhibit Line Col. Sch Line Reported (Decrease) Adjusted Adjustments MACLAY HEALTHCARE CENTER JANUARY 13, 2007 THROUGH DECEMBER 31, 2007 LTC55583G Report References Cost Report Audit Report Explanation of Audit Adjustments RECLASSIFICATIONS OF REPORTED COSTS 15 Not Reported 8A-2 165.07 Administration - DHS Licensing Fees $0 $28,617 $28,617 Not Reported 8A-2 165.11 Administration - Other - Nonlabor * 901,509 (28,617) 872,892 * To reclassify DHS licensing fees for proper cost determination. 42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304 16 Not Reported 8A-2 105.04 Skilled Nursing Care - Other - Nonlabor * $226,794 ($32,667) $194,127 Not Reported 8A-2 165.11 Administration - Other - Nonlabor * 872,892 32,667 905,559 * To reclassify medical director expense to the appropriate cost center. 42 CFR 413.20 and 413.24 CMS Pub. 15-1, Sections 2300, 2302.4 and 2302.8 *Balance carried forward from prior/to subsequent adjustments Page 4 This is trial version www.adultpdf.com State of California Department of Health Care Services Provider Name Fiscal Period Provider Number 30 MC530 Adj. Page or As Increase As No. Exhibit Line Col. Sch Line Reported (Decrease) Adjusted Adjustments MACLAY HEALTHCARE CENTER JANUARY 13, 2007 THROUGH DECEMBER 31, 2007 LTC55583G Report References Cost Report Audit Report Explanation of Audit Adjustments ADJUSTMENTS TO REPORTED COSTS 17 10.1(4) 5 14 8A-2 5.00 Plant Operations and Maintenance * $4,538 ($4,538) $0 10.1(4) 40 14 8A-2 40.00 Property Taxes 75,335 46,454 121,789 * 10.1(4) 65 14 8A-2 65.00 Dietary * 6,965 (6,965) 0 10.1(4) 105 14 8A-2 105.00 Skilled Nursing Care * 82,178 (82,178) 0 10.1(4) 155 14 8A-2 155.00 Social Services * 1,347 (1,347) 0 10.1(4) 160 14 8A-2 160.00 Activities * 2,448 (2,448) 0 10.1(4) 165 14 8A-2 165.00 Administration * (27,826) 27,826 0 10.1(4) 170 14 8A-2 170.00 Inservice Education - Nursing * 3,057 (3,057) 0 To reconcile reported expenses to agree with the provider's general ledger. 42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Section 2304 18 Not Reported 8A-2 165.11 Administration - Other - Nonlabor * $905,559 ($159,357) $746,202 * To adjust home office costs to agree with the filed Home Office Cost Report. 42 CFR 413.17 / CMS Pub. 15-1, Sections 2150.2 and 2304 19 Not Reported 8A-2 165.11 Administration - Other - Nonlabor * $746,202 ($7,960) $738,242 * To eliminate tax penalties and fines not related to patient care. 42 CFR 413.9(c)(3) / CMS Pub. 15-1, Sections 2102.3 and 2122.1 20 10.1(4) 40 8A-2 40.00 Property Taxes * $121,789 ($56,656) $65,133 To adjust property taxes to agree with the property tax invoices. 42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304 21 Not Reported 8A-2 165.11 Administration - Other - Nonlabor * $738,242 ($116,377) $621,865 * To eliminate interest expenses due to insufficient documentation. 42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304 22 Not Reported 8A-2 165.11 Administration - Other - Nonlabor * $621,865 ($4,102) $617,763 * To eliminate travel expenses due to insufficient documentation. 42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304 *Balance carried forward from prior/to subsequent adjustments Page 5 This is trial version www.adultpdf.com State of California Department of Health Care Services Provider Name Fiscal Period Provider Number 30 MC530 Adj. Page or As Increase As No. Exhibit Line Col. Sch Line Reported (Decrease) Adjusted Adjustments MACLAY HEALTHCARE CENTER JANUARY 13, 2007 THROUGH DECEMBER 31, 2007 LTC55583G Report References Cost Report Audit Report Explanation of Audit Adjustments ADJUSTMENTS TO REPORTED COSTS 23 Not Reported 8A-2 165.11 Administration - Other - Nonlabor * $617,763 ($2,001) $615,762 * To eliminate advertising expenses due to insufficient documentation. 42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304 24 Not Reported 8A-2 165.08 Administration - Liability Insurance * $127,604 ($127,604) $0 To eliminate liability insurance expenses due to lack of documentation. 42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304 25 Not Reported 8A-2 165.11 Administration - Other - Nonlabor * $615,762 ($2,630) $613,132 To eliminate bank charges expenses due to insufficient documentation. 42 CFR 413.20 and 413.24 / CMS Pub. 15-1, Sections 2300 and 2304 *Balance carried forward from prior/to subsequent adjustments Page 6 This is trial version www.adultpdf.com State of California Department of Health Care Services Provider Name Fiscal Period Provider Number 30 MC530 Adj. Page or As Increase As No. Exhibit Line Col. Sch Line Reported (Decrease) Adjusted Adjustments MACLAY HEALTHCARE CENTER JANUARY 13, 2007 THROUGH DECEMBER 31, 2007 LTC55583G Report References Cost Report Audit Report Explanation of Audit Adjustments ADJUSTMENT TO REPORTED STATISTICS 26 Not Reported 7 5.00 Plant Operations and Maintenance (Square Feet) 0 1,210 1,210 Not Reported 7 10.00 Housekeeping 0 322 322 Not Reported 7 60.00 Laundry and Linen 0 664 664 Not Reported 7 65.00 Dietary 0 5,629 5,629 Not Reported 7 155.00 Social Services 0 1,300 1,300 Not Reported 7 160.00 Activities 0 448 448 Not Reported 7 165.00 Administration 0 3,463 3,463 Not Reported 7 165.00 Medical Records 0 270 270 11.1(1 of 3) 85 2 7 N/A Total Statistics - Square Feet 32,515 13,306 45,821 11.1(1 of 3) 85 2 7 N/A Total Statistics - Square Feet 32,515 12,096 44,611 11.1(1 of 3) 85 2 7 N/A Total Statistics - Square Feet 32,515 11,774 44,289 To establish the correct square footage in order to properly allocate indirect costs. 42 CFR 413.24 / CMS Pub. 15-1, Sections 2300, 2302.4B and 2306 Page 7 This is trial version www.adultpdf.com State of California Department of Health Care Services Provider Name Fiscal Period Provider Number 30 MC530 Adj. Page or As Increase As No. Exhibit Line Col. Sch Line Reported (Decrease) Adjusted Adjustments MACLAY HEALTHCARE CENTER JANUARY 13, 2007 THROUGH DECEMBER 31, 2007 LTC55583G Report References Cost Report Audit Report Explanation of Audit Adjustments ADJUSTMENT TO REPORTED PATIENT DAYS 27 4.1 05 6 1 12.00 Total Patient Days 47,261 174 47,435 To adjust total patient days to agree with the provider's patient census reports. 42 CFR 413.20 and 413.50 CMS Pub. 15-1, Sections 2205 and 2304 Page 8 This is trial version www.adultpdf.com State of California Department of Health Care Services Provider Name Fiscal Period Provider Number 30 MC530 Adj. Page or As Increase As No. Exhibit Line Col. Sch Line Reported (Decrease) Adjusted Adjustments MACLAY HEALTHCARE CENTER JANUARY 13, 2007 THROUGH DECEMBER 31, 2007 LTC55583G Report References Cost Report Audit Report Explanation of Audit Adjustments ADJUSTMENTS TO OTHER MATTERS 28 Not Reported 1 14.00 Overpayments $0 $30,239 $30,239 * To recover overpayments for overstated Medi-Cal patient days. CCR, Title 22, Section 51458.1 29 Not Reported 1 14.00 Overpayments * $30,239 $2,838 $33,077 * To recover outstanding Medi-Cal credit balances. CCR, Title 22, Sections 50761 and 51458.1 30 Not Reported 1 14.00 Overpayments * $33,077 $129 $33,206 To recover Medi-Cal overpayments because the Share of Cost was not properly deducted from the amount billed. 42 CFR 413.5 and 413.20 / CMS Pub. 15-1, Section 2409 *Balance carried forward from prior/to subsequent adjustments Page 9 This is trial version www.adultpdf.com . Sch Line Reported (Decrease) Adjusted Adjustments MACLAY HEALTHCARE CENTER JANUARY 13, 2007 THROUGH DECEMBER 31, 2007 LTC55583G Report References Cost Report Audit Report Explanation of Audit Adjustments RECLASSIFICATIONS. Adjusted Adjustments MACLAY HEALTHCARE CENTER JANUARY 13, 2007 THROUGH DECEMBER 31, 2007 LTC55583G Report References Cost Report Audit Report Explanation of Audit Adjustments ADJUSTMENTS TO REPORTED COSTS 17. Sch Line Reported (Decrease) Adjusted Adjustments MACLAY HEALTHCARE CENTER JANUARY 13, 2007 THROUGH DECEMBER 31, 2007 LTC55583G Report References Cost Report Audit Report Explanation of Audit Adjustments ADJUSTMENTS