Audit: Mental Health Administration Failed to Check Patients’ Eligibility and Patient Information is not Secure

September 30, 2014

Maryland Department of Health and Mental HygieneState auditors found that the State Mental Health Administration found that the MHA failed to:

  • Keep documentation showing patients who received over $16 million in mental health services were eligible
  • Assure timely reviews/audits of provider claims and perform regular bank reconciliations
  • Maintain adequate security over computers and sensitive patient data
  • Keep adequate internal control over cash receipts

The Mental Health Administration delivers comprehensive care, treatment, and rehabilitation of individuals with mental illnesses, either through a network of hospital facilities operated by MHA or through community service agencies. MHA spent $788 million during fiscal year 2013.

MHA receives funding from multiple federal and state sources and each funding source can have different eligibility rules. Because of this, MHA must keep detailed records about patients so the funding source is correctly matched to each patient service.

Eligibility documentation missing; important statistics not kept

MHA utilizes an Administrative Services Organization (ASO) to review its mental health  services. During fiscal 2013, the ASO paid approximately $16.4 million of State funds for “uninsured” patient care, without keeping documentation showing patients were eligible for the mental health services they received.

The documentation is important because it is the basis for determining who ultimately pays for care: the state, federal government or the individual. This finding was repeated from the previous audit.

In addition, the ASO is required to periodically examine selected providers and supporting documents supporting claims to see if the process is adequate. However, the ASO didn’t target its examinations to a particular kind of claims (uninsured coverage.) Therefore, critical statistics to measure performance related to those claims were not kept.

Untimely audits and bank reconciliations

MHA hired an accounting firm to conduct quarterly independent reviews of provider claims and reconcile a bank account owned by the state and then issue reports of its findings. The Office of Legislative Audits found the quarterly reports were chronically late; from one year to 21 months. These reporting delays adversely affected MHA’s monitoring of the ASO’s payment and reconciliation duties.

Inadequate security over sensitive information

The ASO’s computer system contains typical demographic information for MHA’s beneficiaries, including name, social security number, address, and date of birth. The system also keeps sensitive personal health information, including medical diagnosis codes, prescribed medications, and physician assessments of patient risks, impairments, and substance abuse. OLA found:

  • Several unnecessary and insecure connections were allowed into portions of the ASO’s internal network, thereby placing various network devices at risk.
  • Ineffective intrusion detection associated with encrypted data transmitted over 61 ASO internal network addresses.
  • Third-party networks had unnecessary access to almost all destinations on the ASO internal network via all ports.
  • Personally Identifiable Information (PII) was not protected against unauthorized use and fraud.
  • Access to PII wasn’t limited based on a need-to-know principle. Thus, users had unnecessary read and modification access to certain critical ASO files containing sensitive PII for Maryland Medicaid enrollees.

Control over cash receipts needs improvement

MHA did not verify that collections received through the mail, which totaled approximately $741,000 during fiscal year 2013, were forwarded to and received by DHMH’s general accounting unit for deposit. Also, collections received at MHA’s Crownsville Hospital Center were not adequately controlled and verified. These collections totaled approximately $251,000 during fiscal year 2013. This finding was repeated from the previous audit.

MarylandReporter.com
By Charlie Hayward
CharlieHayward@MarylandReporter.com

2 Responses to Audit: Mental Health Administration Failed to Check Patients’ Eligibility and Patient Information is not Secure

  1. There was a radio host that on September 30, 2014 at 7:44 pm

    busted out laughing when he fought out about the Department of Health and Mental Hygiene. He said you’re kidding me? Nope, thats what it is. Hmmm is that the origin of brain washing?

    Anyway, there was a suicide prevention walk, Out of the Darkness, sponsored by AFSP. It could be that AFSPs resources are not getting to where they need to go. If the county was able to raise 20,000, then a good deal of that should go back into the county. People, when pondering or considering suicide are not going to pick up the phone book and look for a suicide prevention hotline. The suicide prevention hotline phone number needs to be, in big numbers, on a bill board and easy to remember to be effective. Someone needs to see the phone number when they are going to grandpas house to get a gun, or they are going to buy bullets, or they are going to buy rope, or going to buy pills, or they are on their way to a highway where they can gain enough speed to crash. The number needs to be on different billboards throughout the county. People need to remember it when they have the pills in the palm of their hands.
    There are also people who commit suicide in reaction to the criminal justice system, either as a reaction to their sentence or in anticipation of one. The criminal justice system shouldn’t act like people are mentally healthy afterwards, there is no indication in the courts that sentences depress people, that people can’t handle them. There is indication by the courts that mental health services are needed by criminals and suspects, not just victims. If the courts admitted that, a hard look at criminal justice reform would probably take place. So this can be helpful and not just critical,

    1-800-273-TALK (8255) National Suicide Prevention Lifeline.

  2. There was a radio host that on October 2, 2014 at 7:43 pm

    busted out laughing when he found out about the Department of Health and Mental Hygiene. He said you’re kidding me? Nope, thats what it is. Hmmm is that the origin of brain washing?
    Anyway, there was a suicide prevention walk, Out of the Darkness, sponsored by AFSP. It could be that AFSPs resources are not getting to where they need to go. If the county was able to raise 20,000, then a good deal of that should go back into the county. People, when pondering or considering suicide are not going to pick up the phone book and look for a suicide prevention hotline. The suicide prevention hotline phone number needs to be, in big numbers, on a bill board and easy to remember to be effective. Someone needs to see the phone number when they are going to grandpas house to get a gun, or they are going to buy bullets, or they are going to buy rope, or going to buy pills, or they are on their way to a highway where they can gain enough speed to crash. The number needs to be on different billboards throughout the county. People need to remember it when they have the pills in the palm of their hands.
    There are also people who commit suicide in reaction to the criminal justice system, either as a reaction to their sentence or in anticipation of one. The criminal justice system shouldn’t act like people are mentally healthy afterwards, there is no indication in the courts that sentences depress people, that people can’t handle them. There is no indication by the courts that mental health services are needed by criminals and suspects, not just victims. If the courts admitted that, a hard look at criminal justice reform would probably take place. So this can be helpful and not just critical,

    1-800-273-TALK (8255) National Suicide Prevention Lifeline.