DOBSON — The Surry County commissioners voted unanimously Thursday afternoon to reimburse $281,646 to a state agency that manages the Medicaid program, but doing otherwise really was not an option.
“I don’t see that we have any choice — even though it’s painful,” Commissioner Van Tucker said of the sizable payment to the N.C. Division of Medical Assistance (DMA). The reimbursement relates to transports of patients covered by Medicaid, a social health-care program for families and individuals with limited resources.
It stems from an overpayment from the state agency to Surry County in the 2011 fiscal year.
That agency reimburses the county for its EMS services provided to Medicaid patients, and in order to calculate the reimbursement rate for each Medicaid transport the EMS must determine how much it costs to transport a patient.
Total expenditures are divided by total numbers of transports to arrive at an expense per trip, according to a memo explaining the process from county Finance Office Sarah Bowen to the commissioners and county manager
But in 2011, a total of 4,963 transports was reported by the EMS, when it actually transported 8,934 patients, according to Bowen’s memo.
The error in reporting led the average cost per transport to exceed $1,000, while the actual cost should have $592.31 based on the correct number of total transports. So when the Division of Medical Assistance used the higher figure to calculate what it owed the county for transporting Medicaid patients, the result was inflated by more than $281,000.
Bowen explained to the commissioners Thursday, during a special called meeting, that the overpayment for 2011 was discovered during a DMA audit. Her earlier memo stated that the matter doesn’t end there, with Surry County also expected to owe additional sums for later years because of the same problem — an estimated $815,000.
The county board was faced with the pressing matter Thursday of approving the $281,646 reimbursement for 2011, which if received on or after Sept. 1 would have ballooned to $309,811 due to a 10-percent penalty.
No appeal process
Yet that reality did not keep the commissioners from pressing for wiggle room during the special meeting.
The county finance officer fielded a series of questions from Commissioner Tucker in particular about whether Surry had any recourse or cause for appeal.
“Do we feel like Medicaid is right absolutely in seeking their money back?” he said. “Is there a gray area?”
The answer was no, with both Bowen and County Attorney Ed Woltz explaining that it was the county’s fault for not providing accurate numbers.
It was noted during the meeting that each year Surry is asked to provide a cost report reflecting accurate figures for transports, which is done by a third-party vendor.
That fact also opened up another line of questioning from Tucker as to whether there is any contractual recourse, language or liability on the part of the vendor — “our watchdog that did not bark?”
“We didn’t give them what they needed to do their job,” the attorney said of the figures the third-party vendor relied on which were generated locally.
The good news is that the county now has gotten to the bottom of the issue with Medicaid reimbursements.
“We know what the error was and how to correct it,” Bowen said of the problem spanning four years.
Surry Emergency Services Director John Shelton, who attended Thursday’s meeting, said that Bowen, who became finance officer in the early part of this year, has helped clarify what the county needs to turn in to “match their numbers” at the state level.
Shelton also suggested that the nuances of the joint federal and state health program were at least partly responsible.
“Historically, with Medicaid you can never get a direct answer,” he said of reimbursement rates, adding that local personnel have been told different stories about that.
“Our folks have never been told how it is to be calculated,” Shelton added. “There’s been no guidance from them on how to do this.”
In response to another question from Tucker, Bowen said she doesn’t know at this time if other counties have experienced the same problem.
Commissioner Larry Phillips wondered Thursday if any accounting mechanism can be built in to monitor the Medicaid reimbursement process to keep a similar problem from occurring in the future — “something that would flag us,” he said.
“There needs to be a simple, timely, accurate reporting,” Phillips said.
“We’re having to go back four years and pay for this.”
Westfield lease approved
Also Thursday, the commissioners gave their unanimous nod to a lease agreement for the use of Westfield Community Center.
The center has lacked a tenant since the commissioners voted to terminate a previous county lease agreement with the Westfield Boosters Club in early 2015, due to the club’s failure to obtain liability insurance.
Under the pact approved Thursday, the new occupant will be Mount Airy Indoor Soccer and Sports, LLC.
That group will use the facility for community and recreational programming.
The lease, to go into effect soon, requires Mount Airy Indoor Soccer and Sports to pay $800 per month for use of the center. The initial period of the lease is six months, and can be extended for two additional one-year periods.
Under the agreement, the county is to fund the installment of a 220-volt electrical line to accommodate a clothes dryer at the center.
Mount Airy Indoor Soccer and Sports is required to maintain liability insurance of no less than $1 million to cover all activities on the premises.
“I’m tickled that someone wants to use that facility,” Commissioner Larry Johnson said Thursday. He mentioned that this is good for both the Westfield community and the county.
Tom Joyce may be reached at 336-415-4693 or on Twitter @Me_Reporter.