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St. Lawrence County eats $1.6 million loss in Public Health

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CANTON — Closing the books on two longtime agencies of the St. Lawrence County Public Health Department revealed a $1.6 million shortfall that will come out of the county’s $6.5 million fund balance.

The loss came to light when a billing reconciliation was done for the Certified Home Health Agency, which closed in 2013, and its sister agency, the Long-Term Health Care Agency, transferred its last patient in March.

“Unfortunately, it’s going to be a bitter pill,” Legislator Alex A. MacKinnon, R-Fowler, said. “I hope we’ve reached the bottom.”

One bright note in Monday’s legislators’ meeting was news from Administrator Karen M. St. Hilaire that the county will receive $500,000 more than it expected as part of a 1998 settlement with tobacco companies. The loss from Public Health and the additional tobacco money brings the fund balance to $5.4 million.

Legislator Kevin D. Acres, R-Madrid, questioned how the county will meet its five-year plan of staying within the state’s tax cap.

“Where do we stop spending?” Ms. St. Hilaire said. “I don’t have that answer yet.”

As part of the reconciliation, staff from Public Health and the county Treasurer’s Office, along with Ms. St. Hilaire, determined that Public Health miscalculated its 2011 revenue as $3.5 million when the correct amount was $2.6 million, an overstatement of $904,562.

On top of that, they determined that outstanding billing was $793,215. The staff so far has received about $20,000 from reviewed cases. As much as $50,000 may be collected from the remaining balance, leaving $725,000 that probably will be uncollectible.

In some cases, Medicaid reduced payments or changed the rules midstream. Elsewhere, insurance companies paid less than what was billed and the difference was never adjusted, or else the bills were not pursued in a timely manner and are too old to collect.

Part of the problem was a disconnect between the Public Health billing system and the county’s financial program. With no further revenue coming in, the problem became clear, Ms. St. Hilaire said.

She wants the state Comptroller’s Office to conduct an audit to answer any remaining questions and for the county to meet its fiscal obligations. She also wants Treasurer Kevin M. Felt’s office to audit every department’s financial policies and procedures.

An audit could create a timeline for the breakdown, Legislator Jason A. Clark, D-Norfolk, said. He suggested enlisting the help of the Wladis Law Firm, which lobbies for the county, to appeal to the state for further Medicaid reimbursement.

Staff turnover also played a part in the department’s financial troubles. Six people over the last decade have served as fiscal manager. “It has been difficult,” said Debra L. Bridges, the latest to fill the position. “It’s not due to lack of effort.”

Similar problems may pertain to other departments, Legislator Vernon D. “Sam” Burns, D-Ogdensburg, said.

“What I’m worried about is all the other software programs that we use for billing so that we understand all the pitfalls,” he said. “It’s important we do the cross-training. We have to allow our employees time to do this. Otherwise, this is what happens.”

The county had warning signs that all was not well in Public Health, including when accounts receivable did not match up with billable hours, several legislators said.

“You guys had severe red flags,” Legislator Mark H. Akins, R-Lisbon, said. “You were using projections off of bad numbers.”

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