New state audit slams rehabilitation service costs
The state auditor released a performance audit Thursday of Utah's Division of Rehabilitation Services, citing four negative findings and recommending that lawmakers consider moving the agency from the state Office of Education to another department such as Workforce Services.
The audit's release comes one day before the retirement of Don Uchida, who has directed the Utah State Office of Rehabilitation (USOR) since 2006 but worked within the agency for 45 of its 92 years. Russell Thelin, who has directed the office's Division of Rehabilitation Services since 2006, will take his place.
Uchida, 68, said the timing is purely coincidental his wife asked him to retire eight years ago and his planned exit from the agency has been in the works for two years.
The audit found no examples of fraud or abuse, but suggested tighter financial controls.
Among the findings:
• Counselors did not fully comply with policy in 15 client motor vehicle modifications authorized from 2010 through 2012. The audit questioned whether those were the most cost-effective alternatives and said an estimated $143,000 in modifications may have been unnecessarily approved.
• The division does not enforce existing controls designed to ensure that direct payments to clients are used for their intended purpose, bringing into question almost $350,000 paid out over three years. The audit recommended paying authorized vendors directly for goods and services to reduce potential misuse of funds.
• The division could have reduced medical costs by approximately $612,000 per year by using the Medicaid rate for medical claims rather than its current fee schedule. It could realize additional savings by authorizing only Medicaid-approved procedures. About one-third of the 2,599 medical authorizations reviewed between 2010 and 2012 were not covered by Medicaid, with the most common outlier being the psychiatric diagnostic interview exam. The audit questioned whether it was necessary to fulfill the agency's purposes.
Current policy allows the agency to pay up to 150 percent of established Medicaid rates, Uchida said, "halfway between what workers' compensation pays and Medicaid."
"We had to find a happy medium," Uchida said, pointing to the shrinking pool of physicians who accept Medicaid.
• Counselors do not verify applicants' identity by requesting documentation. This increases the risk of fraud and identity theft while also prolonging unemployment for some clients. Counselors rarely asked for green cards or verification of eligibility to work in the U.S. Such documents can take up to 90 days to obtain, and the audit recommends that the division obtain those papers before implementing a client's employment plan.
Down to cases • The audit got down to specifics in several cases.
In one instance, auditors cited $63,000 spent to outfit the vehicle of an agency counselor turned client. Arrangements should have been made to reassign the employee instead, auditors said, also suggesting that cheaper transportation could be found, such as public transit or rides with family and friends.
"While public transportation may not be as convenient as owning a vehicle, it appears to be a reasonable option that was not given adequate consideration prior to authorizing costly vehicle modifications," the audit said.
The audit also suggested that a quadriplegic who was granted a vehicle modification take the bus instead. The client resisted that option, saying that UTA's paratransit buses which bridge the gap from home to the regular bus stop would arrive up to 15 minutes early and as much as 36 minutes late, causing him to miss his college classes.
In one instance, funds were used to install an elevator in a client's home. The audit expressed concern that the woman's job was not in jeopardy since she was given a year's leave to recover from an accident.
"It does not appear that the presence of an elevator in her home would be a significant factor in her ability to retain her employment," the report said,
In their written response, Uchida and Martell Menlove Utah's Public Instruction superintendent accepted the audit's findings, pledging to review and revise current transportation policies, direct payment guidelines and eligibility documentation to ensure compliance with federal guidelines and the audit's recommendations.
However, they noted that the agency spends over $20 million per year on direct client services, of which vehicle modifications make up a very small percentage.
"The real expensive modifications are for people who are quadriplegics," Uchida told The Salt Lake Tribune, noting that his office is constrained by federal law to lay out options and offer eligible clients "informed choice."
For quadriplegics in power chairs, "clients chose the most independence they could get," Uchida said.
Close to 80 percent of agency funding flows from the U.S. Department of Education, which also monitors his office each year, Uchida said.
In response to the audit, the agency plans to hire its own internal firstname.lastname@example.org
Utah's Division of Rehabilitation Services ranked above the national average with a 58 percent rehabilitation rate, of which 63 percent of clients work 35 or more hours per week and earn an average $11.40 per hour. Utah's average rehabilitation costs $4,862.
Source: Utah State Auditor The State Auditor will present these findings to members of the Legislature's Social Services Appropriations Subcommittee Thursday at 11:35 a.m. in Edison Elementary School's gymnasium, 466 S. Cheyenne (1525 West), Salt Lake City.