Wednesday, March 24, 2010

Mecklenburg residents look at how government spends money and find interesting numbers

As news of closings and layoffs because of budget woes hits staffers and users of schools and libraries in Mecklenburg County, reporter April Bethea of The Charlotte Observer wrote a post asking residents to help cut money elsewhere.

This money talk on the surface is not sexy stuff, but money for everyone will continue to tighten in the next fiscal year, endangering county services and the employment of some of our neighbors into 2011 and beyond.

As of Wednesday morning, Bethea had about 45 responses, and some provided surprising details. Commenter JAT, who appears to be Jeff Taylor of the conservative Meck Deck blog, shared some shocking numbers of money paid to cab services for transportation for the Department of Social Services in the previous fiscal year. He provided a PDF link to one document, from Fiscal Year 2008-09, that showed two cab companies getting $4.5 million combined in reimbursements. The DSS spending document, a detailed 1,311 pages, is available now on Google Docs.

And yes, $4.5 million:
$2,302,372 for Crown Cab Co.
$2,249,903 for AA Prestige Taxi Service,
in Fiscal Year 2008-2009.

One line item for AA Prestige shows a bill dated Oct. 6, 2008, for Medicaid transportation services for trips from Sept. 22 to Sept. 28, seven days, at a cost of $35,376.71, or about $5,000 per day.

Many of those payments, however, were attributed to Medicaid and the N.C. Department of Transportation’s ROAP, which I think is the Rural Operating Assistance Program, funded by federal money passed through the state.

That federal Medicaid transportation money is supposed to be managed at the county level, according to one state document available on Google Docs. This document, a report by the Department of Health and Human Services, shared an examination of Medicaid management by North Carolina and suggested “areas of vulnerability,” in December 2008, during the same period of the high payments to the two cab companies.

One area of vulnerability: “Not adequately conducting oversight of the NEMT program.” NEMT is non-emergency medical transportation program.

The document says that each county in North Carolina is responsible for its own NEMT program, but oversight could be better:

“DMA (the N.C. Division of Medical Assistance) has advised that they have not consistently checked on whether the counties verify delivery of services, check for exclusions, and request disclosures regarding owners and managing employees."

Total state NEMT payments during Fiscal year 2007 were more than $33 million, which was offset against each county’s share of Medicaid reimbursement, the document says, and a review examined one month of services in 60 counties for 2002 to 2007. The review showed $38,380 in billing inconsistencies during that month and numerous procedural issues.

The report recommended consistent oversight of the NEMT program, including guidance to the counties to verify the delivery of services billed, recover overpayments identified in the state’s review and return the federal share. The document also calls for a statewide audit.

So the large numbers in the local DSS budget paid to cab companies in Mecklenburg County likely are mostly federal dollars, and are merely documented on Mecklenburg County’s social services budget. Scrutiny of them won’t save library and school jobs.

But Bethea’s smart call for ideas and the responses from readers have unearthed some interesting hints of other ways tax money could be spent more wisely. Her method also shows a way that county residents can sort through information overload to help keep an eye on government spending. Jeff Taylor of the Meck Deck deserves credit for examining the document and raising the issue.

N.C. Gov. Bev Perdue has plans for a press conference today to announce a plan to oversee Medicaid spending, according to a Twitter feed from her office. Some details of the Medicaid plan are available at WRAL.

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