What Was Performed? An examination of The Moorings at Lewes Nursing Home’s fiscal records of the
Delaware Department of Health and Social Services, Division of Medicaid and Medical Assistance, Medicaid
Long-Term Care Facilities’ Statement of Reimbursement Costs for Skilled and Intermediate Care Nursing
Facilities – Title XIX and Nursing Wage Survey (cost report and nursing wage survey, respectively) for fiscal
year ended June 30, 2018.
WhyThis Engagement? This engagement was conducted in accordance with federal requirements (42 CFR
447.253 and 483 Subpart B) and state requirements (Title XIX Delaware Medicaid State Plan, Attachment
4.19D) (criteria), as applicable to The Moorings at Lewes Nursing Home’s fiscal records. The criteria were
used to prepare the Schedule of Adjustments to the Trial Balance, Patient Days, and Nursing Wage Survey
for fiscal year ended June 30, 2018 found in the report.
The State of Delaware is required to ensure that the fiscal records at the nursing care facilities are retained and
properly support the cost report, or the financial report showing the cost and charges related to Medicaid activities,
submitted to the Medicaid Agency. These costs must be compliant with federal and state regulations.Under the
Delaware Medicaid State Plan, the state is required to examine a sample of facilities located within the state
to ensure the facilities’ cost reports and nursing wage surveys are compliant with federal and state
What Was Found? The examination identified two findings, with each finding resulting in both a material
weakness in internal control and a compliance finding:
▪ The facility did not provide the general ledger and supporting documentation for the period of July
1, 2017 through September 30, 2017.
▪ The facility did not provide sufficient supporting documentation for salary expense for the period of
July 1, 2017 through December 31, 2017.
The facility was unable to provide the above detail support for certain costs, with the total amount of
untested costs being approximately $2.1 million (34.3% of total costs) on the cost report and nursing wage
survey. As a result, we were unable to obtain sufficient appropriate evidence about the accuracy and
allowability of these costs. We were also unable to determine whether adjustments to these amounts were
necessary, and whether management’s assertions related to these costs are accurate. Not being able to
support the costs recorded could result in a disallowance of those costs, which would affect the facility’s
The Moorings at Lewes Nursing Home Long-Term Healthcare Facility Examination for Fiscal Year ended
June 30, 2018, can be found here.
For any questions regarding the attached report, please contact State Auditor Kathleen K. McGuiness at
GAO's Yellow Book, Generally Accepted Government Auditing Standards (GAGAS)