Audit 3186

US Department of Treasury Program Name: Coronavirus State and Local Fiscal Recovery Fund CFDA# 21.027 Finding: 2022-007 Untimely Adoption of Policy SIGNIFICANT DEFICENCY Criteria: "In accordance with the U.S. Department of Treasury 31 CFR Part 35, Coronavirus State and Local Fiscal Recovery Funds Final Rule and the Uniform Guidance, General Financial Management Internal Controls, Eligible Projects Determination & Documentation Policy, Cost Principles/Allowable Costs Policy, Civil Rights Compliance / Nondiscrimination Policy, Records Retention Policy are required to be adopted as condition of receiving the funds." Condition: The County expended the funds as revenue replacement without adopting the policies specific to the federal award. Effect: The County could use the funds for unallowable costs that were prohibited by the Final Rule. Cause: County oversight of the new federal grant requirement to have the stated policies in place. Recommendation: The finance office should review the grant agreement and the Uniform Guidance more carefully to ensure all compliance requirements are meet. Views of responsible officials and planned corrective actions: The County agrees with the finding. See the response in the corrective action plan.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA# 93.778 Finding: 2022-008 Untimely Review of SSI Termination SIGNIFICANT DEFICENCY Eligibility Criteria: "The State sends notification to the County when a participant is no longer eligible under SSI determination. The County has a certain time period to initiate an ex parte review to determine whether the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for the Aged, Blind and Disabled." Condition: There was 1 applicant/beneficiary not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Section III. Federal Award Findings and Questioned Costs (continued) Context: "We examined 60 cases from of a total of 317,958 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. " Effect: "The County did not initiate ex parte review timely, therefore, no eligibility review was completed in the required time period. The lack of follow up and certification could lead to applicants receiving Medicaid benefits for which they were not eligible." Cause: Ineffective communication between departments within the Department of Social Services. One area within DSS received State communications that applicants would no longer be eligible for SSI benefits and the County needed to conduct an application process. This information was not shared with other departments in DSS from which the recipient was also receiving benefits. Recommendation: Any State communications related to applicants’ benefits received by any DSS department should be shared with all areas from which the participant receives benefits. State files should be reviewed internally to ensure all actions have been properly closed and the corrective action has been taken. Workers should be retrained on what process needs to be followed when State communications are received. Views of responsible officials and planned corrective actions: The County agrees with the finding. See the response in the corrective action plan.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA# 93.778 Finding: 2022-009 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: "In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits." Condition: There were 9 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: "We examined 60 cases from of a total of 317,958 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. " Section III. Federal Award Findings and Questioned Costs (continued) Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. Identification of a repeat finding: "This is a repeat finding from the immediate previous audit, 2021-005." Cause: "Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. " Recommendation: "Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. " Views of responsible officials and planned corrective actions: The County agrees with the finding. See the response in the corrective action plan.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA# 93.778 Finding: 2022-010 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: "Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or non-countable resources and explained within the documentation. " Condition: There were 4 errors discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: "We examined 60 cases from of a total of 317,958 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. " Effect: "For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received assistance for which they were not eligible." Section III. Federal Award Findings and Questioned Costs (continued) Identification of a repeat finding: "This is a repeat finding from the immediate previous audit, 2021-006." Cause: "Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. " Recommendation: "Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. " Views of responsible officials and planned corrective actions: The County agrees with the finding. See the response in the corrective action plan.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA# 93.778 Finding: 2022-011 Inadequate Request for Information SIGNIFICANT DEFICENCY Eligibility Criteria: "In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. Electronic matches are required at applications and redeterminations. " Condition: There were 22 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: "We examined 60 cases from of a total of 317,958 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. " Effect: "For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received assistance for which they were not eligible." Identification of a repeat finding: "This is a repeat finding from the immediate previous audit, 2021-007." Cause: "Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. " Section III. Federal Award Findings and Questioned Costs (continued) Recommendation: "Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. " Views of responsible officials and planned corrective actions: The County agrees with the finding. See the response in the corrective action plan.

US Department of Treasury Program Name: Coronavirus State and Local Fiscal Recovery Fund CFDA# 21.027 Finding: 2022-007 Untimely Adoption of Policy SIGNIFICANT DEFICENCY Criteria: "In accordance with the U.S. Department of Treasury 31 CFR Part 35, Coronavirus State and Local Fiscal Recovery Funds Final Rule and the Uniform Guidance, General Financial Management Internal Controls, Eligible Projects Determination & Documentation Policy, Cost Principles/Allowable Costs Policy, Civil Rights Compliance / Nondiscrimination Policy, Records Retention Policy are required to be adopted as condition of receiving the funds." Condition: The County expended the funds as revenue replacement without adopting the policies specific to the federal award. Effect: The County could use the funds for unallowable costs that were prohibited by the Final Rule. Cause: County oversight of the new federal grant requirement to have the stated policies in place. Recommendation: The finance office should review the grant agreement and the Uniform Guidance more carefully to ensure all compliance requirements are meet. Views of responsible officials and planned corrective actions: The County agrees with the finding. See the response in the corrective action plan.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA# 93.778 Finding: 2022-008 Untimely Review of SSI Termination SIGNIFICANT DEFICENCY Eligibility Criteria: "The State sends notification to the County when a participant is no longer eligible under SSI determination. The County has a certain time period to initiate an ex parte review to determine whether the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for the Aged, Blind and Disabled." Condition: There was 1 applicant/beneficiary not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Section III. Federal Award Findings and Questioned Costs (continued) Context: "We examined 60 cases from of a total of 317,958 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. " Effect: "The County did not initiate ex parte review timely, therefore, no eligibility review was completed in the required time period. The lack of follow up and certification could lead to applicants receiving Medicaid benefits for which they were not eligible." Cause: Ineffective communication between departments within the Department of Social Services. One area within DSS received State communications that applicants would no longer be eligible for SSI benefits and the County needed to conduct an application process. This information was not shared with other departments in DSS from which the recipient was also receiving benefits. Recommendation: Any State communications related to applicants’ benefits received by any DSS department should be shared with all areas from which the participant receives benefits. State files should be reviewed internally to ensure all actions have been properly closed and the corrective action has been taken. Workers should be retrained on what process needs to be followed when State communications are received. Views of responsible officials and planned corrective actions: The County agrees with the finding. See the response in the corrective action plan.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA# 93.778 Finding: 2022-009 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: "In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits." Condition: There were 9 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: "We examined 60 cases from of a total of 317,958 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. " Section III. Federal Award Findings and Questioned Costs (continued) Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. Identification of a repeat finding: "This is a repeat finding from the immediate previous audit, 2021-005." Cause: "Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. " Recommendation: "Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. " Views of responsible officials and planned corrective actions: The County agrees with the finding. See the response in the corrective action plan.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA# 93.778 Finding: 2022-010 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: "Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or non-countable resources and explained within the documentation. " Condition: There were 4 errors discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: "We examined 60 cases from of a total of 317,958 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. " Effect: "For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received assistance for which they were not eligible." Section III. Federal Award Findings and Questioned Costs (continued) Identification of a repeat finding: "This is a repeat finding from the immediate previous audit, 2021-006." Cause: "Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. " Recommendation: "Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. " Views of responsible officials and planned corrective actions: The County agrees with the finding. See the response in the corrective action plan.

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA# 93.778 Finding: 2022-011 Inadequate Request for Information SIGNIFICANT DEFICENCY Eligibility Criteria: "In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific standards, and documentation must be maintained to support eligibility determinations. Electronic matches are required at applications and redeterminations. " Condition: There were 22 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: "We examined 60 cases from of a total of 317,958 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to re-determine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. " Effect: "For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received assistance for which they were not eligible." Identification of a repeat finding: "This is a repeat finding from the immediate previous audit, 2021-007." Cause: "Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. " Section III. Federal Award Findings and Questioned Costs (continued) Recommendation: "Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers should be retrained on what files should contain and the importance of complete and accurate record keeping. We recommend that all files include online verifications, documented resources of income and those amounts agree to information in NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. " Views of responsible officials and planned corrective actions: The County agrees with the finding. See the response in the corrective action plan.