Read a state audit ... and weep

Warning: Missourians who actually believe they are receiving services from Jefferson City commensurate with their individual tax checks are warned that some passages printed here may be hazardous to their health. Care should be exercised when reading the following audit information, and readers with high blood pressure should protect themselves with prescribed medications before proceeding. Don't say you haven't been warned.

KENNETT, Mo. --

During fiscal year 1999, total state and federal expenditures for inpatient and outpatient hospital services were approximately $1 billion. Although there are about 150 hospitals in the state that receive Medicaid funding, the Department of Social Services had only performed 18 final cost reports during the year ended June 30.

The report found some recipients were receiving benefits in Missouri and at least one surrounding state.

Some prison inmates were incorrectly receiving benefits, which is prohibited by both federal and state law.

Some recipients had not correctly reported the value of their automobiles and, as a result, had received benefits that they were not entitled to.

Medicaid benefits were paid on behalf of some recipients after they had died.

A state auditor's report on St. Louis Regional Cancer payments for mental retardation clients who live in community placement facilities reports a "lack of control" over the spending allocations. In a two-year period (fiscal years 2001 and 2002) the program overspent appropriated allocations by more than $2 million.

Missouri's Medicaid outpatient prescription drug costs have more than doubled in the last five years and totaled $770 million in fiscal year 2001.

Auditors found the state has not been as active as other states with certain containment programs, such as preferred drug lists or prior authorization. Auditors calculate the state could have saved a estimated $1.5 million on the $8.4 million spent on drugs in fiscal year 2001 if more accurate prices had been used.

The Department of Social Services hired a pharmacy program director who previously worked as a lobbyist for the Missouri Pharmacy Association and continues to own at least one pharmacy.

The state reimbursed pharmacists $320,000 more than necessary in fiscal year 2001 as the result of using a higher maximum reimbursement rate for insulin.

For years the state has allowed pharmacies to keep some recipient co-payments, known as share dispensing fees, in lieu of increasing prescription dispensing fees. Pharmacists kept an estimated $3 to $6 million in shared dispensing fees for fiscal year 2001.

The Department of Social Services does not maintain any data on the shared dispensing fee amounts kept by pharmacies.

It appears that an outlay of an additional $134 million will be needed before the state's court automation program is completed. This added amount is in addition to the $4.06 million spent annually on the program, originally estimated to be fully funded in 1999. The annual cost of maintaining the automated case management system upon implementation (probably through fiscal 2009) will be $18 million annually.

According to an audit of the Department of Corrections' Inmate Revolving Fund, more than $4 million is owed the state by offenders enrolled in the program.

At the time the audit occurred, 12,800 offenders owed money for their share of rehabilitation programs. Auditors also found undeposited receipts totaling over $191,000 due from current and former inmates.

Auditors also discovered the loss of a check of more than $450,000 received from the state education agencies for representing federal grants and state general revenue allocations.

Unreimbursed state fringe benefit costs could reach as high as $4.8 million by 2006 because corrections officials have failed to determine that the medical services contractor has appropriately reimbursed the state for benefit costs incurred by agency employees.

Adding insult to injury, the agency has not fully used federal assistance programs and appears to have lost future U.S. grants for the substance abuse treatment programs. These costs have been paid from the state's general revenue fund rather than from the department's federal fund appropriation.

The state's general revenue fund is subsidizing the operations of the inmate canteens by nearly $2.8 million annually.

Auditors discovered some $3.8 million has been spent on the Missouri Teacher Education Scholarship program since teacher incentives were inaugurated. The department has never determined or evaluated if these programs have increased the number of teachers in public schools.

Auditors reported the program's database was in such disarray that much of the data had to be recreated.

Auditors also found that nearly 40 percent of the Teacher Education Scholarship program and nearly half of the state's Minority Teacher Education Scholarship did not complete the requirements outlined by the state's incentive regulations. If requirements are not met, the scholarship amount is treated as a loan and must be repaid to the state.

Missouri spends more per capita on conservation efforts than its eight neighboring states and has the nation's third-largest conservation budget.

In the 24 years the state has collected sales taxes earmarked for conservation, officials have spent more than $2 billion acquiring 774,000 acres, starting programs and building infrastructure.

Auditors found the agency has not formally assessed project benefits and has not provided oversight of the $10 million granted to local and federal entities. Since 1993, it has granted $2.3 million to Ducks Unlimited but cannot assess how the money is spent because of a secrecy agreement required by Ducks Unlimited.

Jack Stapleton is the editor of Missouri News & Editorial Service.