Audit Report on the New York City Department for the Aging’s Controls over Payments for Home Care Services
Executive Summary
The Department for the Aging (DFTA) has contracts with hundreds of community-based organizations to provide a variety of services which are overseen by DFTA’s Bureau of Social Services. DFTA contracts with Case Management Agencies (CMAs) and Home Care Agencies (HCAs) to assist older adults (clients) with daily living activities.
CMAs are responsible for recording the types of service to be provided and the number of authorized hours of service in the Senior Tracking Analysis and Reporting System (STARS), DFTA’s system of record for tracking client information and hours of service provided. Clients can receive a maximum of 20 hours of services a week.
HCAs submit monthly invoices to DFTA that indicate the total number of hours provided and the requested reimbursement amount (which is based on the hours worked and the negotiated hourly rate).[1] The hours recorded in STARS should match those billed on the invoices. To monitor compliance with the contracts and the program, DFTA conducts an annual performance evaluation of each HCA. In addition, DFTA is required to perform a contract close-out audit and to arrange for a CPA firm through the Mayor’s Office of Contract Services (MOCS) to conduct a programmatic audit at the end of each fiscal year.
The total amount paid to the HCAs during Fiscal Years 2020 and 2021 was $67,000,158.
Audit Findings and Conclusion
The audit found that DFTA lacked an adequate review and reconciliation process to assess HCAs’ reporting of services provided to clients and their invoicing of those services. DFTA did not review time records to verify that the payments rendered by DFTA were for service hours actually provided, and did not perform other compliance tests which would identify potential issues. These are addressed more fully below.
The audit also found that DFTA ensured that the invoices paid to HCAs for services provided during Fiscal Years 2020 and 2021 were generally calculated correctly, that all paid invoices were approved, and that all advances provided to HCAs during Fiscal Years 2020 and 2021 were recouped. DFTA officials were responsive throughout the audit and receptive to the audit’s recommendations.
Audit Recommendations
The audit makes several recommendations that aim to improve DFTA’s controls over its payments to HCAs for home care services. These appear in the body of this report.
Agency Response
In its response, DFTA agreed to implement the audit’s recommendations.
[1] DFTA reimburses the HCAs for each hour of service provided based on the rate outlined in each of their contracts.