(The Center Square) — A recent legislative audit uncovered multiple issues at the Central Louisiana Human Services District, including a failure to collect self-generated revenues and delinquent debt and loose oversight over employee time sheets.

Louisiana Legislative Auditor Mike Waguespack issued an audit report for the agency that provides mental health services in an eight-parish area on Monday. It found for the third consecutive review the agency did not bill Medicare and Medicaid in accordance with insurers’ contract terms, resulting in a failure to collect $160,802 in self-generated revenues during the two fiscal years ending in June 30, 2022.

“Good business practices require that insurers’ contracts be obtained and terms met before

providing and billing for services to avoid denied claims and lost revenues,” according to the report. “Management should continue to strengthen controls over its billing process to ensure insurer contracts are obtained and to ensure all claims submitted for payment to insurers for services provided to patients adhere to contract terms.”

Auditors also found CLHSD failed to comply with an agreement with the Office of Debt Recovery for the collection of delinquent debt, which increases the risk accounts will become uncollectable.

The 2020 agreement required CLHSD to authenticate all debt, including the amount, liability, and the debtor’s identifying information. The arrangement also required CLHSD to send out requests for payment and notify ODR of delinquent accounts after 60 days.

Other significant issues centered on CLHSD’s lack of adequate internal controls to ensure proper time and attendance records. A review of 4,673 electronic timesheets between July 1, 2020 and May 1, 2022 found 305, or 6%, were not certified by the employee or were certified after the payroll posting date.

Another 883 timesheets, or 18%, were not approved by a supervisor, or were approved past the posting date.

CLHSD Executive Director Rebecca Craig responded to the findings in a July 26 letter to Waguespack that blamed some of the issues on COVID, hurricane response and staffing issues.

“Our inability to recruit and retain persons with the necessary qualifications (i.e., Licensed Clinical Social Workers and psychiatrists) in the Central Louisiana area is the main reason for the $151,870 finding. From a licensure standpoint, Licensed Professional Counselors, Medical Psychologists, and licensed, registered, and certified addictions counselors can provide needed behavioral health treatment. Because Medicare does not credential these professionals, those services are not paid.”

“CLHSD makes every effort to have credentialed staff provide services to Medicare clients, and CLHSD made some procedural changes to eliminate Medicare clients receiving services from un-credentialed staff,” Craig wrote. “However, the advent of COVID and significant hurricane responses during this audit period impacted the availability of Medicare credentialed providers that we had available.”

Craig blamed the $8,932 in services provided to patients with insurers CLHSD was not contracted with on “our delay in successfully becoming providers with Molina Medicaid.”

Craig wrote that the issue with time sheets centers on “mitigating circumstances that delay certification or approval,” such as medical leave. She outlined corrective action plans for the time sheets, as well as the billing issues.

The issue regarding CLHSD’s failure to comply with its agreement with the Office of Debt Recovery was remedied when the agency outsourced its billing services in May 2022, she wrote.