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 was one error discovered during our procedures that lacked the appropriate ex parte review and three errors in which erroneous income evidence was used during eligibility determinations. Four applicants/beneficiaries receivedassistance for which therecipient was not eligible. Questioned Costs: The amount of claim paid on behalf of the above ineligibility error resulted in a questioned costs of $3,486.69 Context:Weexamined120Medicaidtransactionsoutof637,152tore-determineeligibility. Thesefindingsweredisclosedinaseparatelyissued spreadsheet to the North Carolina Department of Health and Human Services and 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 affect countable resource and a participant could have been approved for benefits that they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2024-001. Cause:Ineffectiverecordkeepingandineffectivecasereviewprocess,incomplete documentation,andincorrectapplicationofrulesforpurposes of determining eligibility. Recommendation:Filesshouldbereviewedinternallytoensureproperdocumentationisinplaceforeligibility.Workersshouldberetrainedon what files should contain and the importance of complete and accurate record keeping.Werecommend thatall filesinclude online verifications, documented resources of income and those amounts agree to information in NC FAST. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviewstoensureproperdocumentationiscontainedinfilestosupporteligibilitydeterminations.Workerswillberetrainedonwhatinformation should be maintained incase files,the importance of complete and accurate record keeping,and reserve calculations. The County finance office will also participate in the review process.
Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the applicationandtheseitemswillagreetoreports intheNCFAST system. Inthisprocess,documentation shouldbepresentandagreebacktothe records in the NC FAST system. Any items discovered in the process should be considered resources and explained within the documentation. Condition: There were twenty-seven (27) technical 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. The errors were as follows: Ten (10) cases had instances of failure to complete atleast one compliance component, Ten (10) cases of inaccurate resource calculations in NC FAST, and Seven (7) cases of inaccurate budget calculations in NC FAST. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context:Weexamined120Medicaidtransactionsoutof637,152tore-determineeligibility. Thesefindingsweredisclosedinaseparatelyissued spreadsheet to the North Carolina Department of Health and Human Services and 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 affect countable resource and a participant could have been approved for benefits that they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2024-002. Cause:Ineffectiverecordkeepingandineffectivecasereviewprocess,incomplete documentation,andincorrectapplicationofrulesforpurposes of determining eligibility. Recommendation:Filesshouldbereviewedinternallytoensureproperdocumentationisinplaceforeligibility.Workersshouldberetrainedon what files should contain and the importance of complete and accurate record keeping.Werecommend thatall filesinclude online verifications, documented resources of income and those amounts agree to information in NC FAST. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviewstoensureproperdocumentationiscontainedinfilestosupporteligibilitydeterminations.Workerswillberetrainedonwhatinformation should be maintained incase files,the importance of complete and accurate record keeping,and reserve calculations. The County finance office will also participate in the review process.
Criteria: Food and Nutrition Services case files to require proper documentation be contained in the case record to verify eligibility. The case file should contain a completed, signed (telephonic signature is allowable) and dated Food and Nutrition Services application (DSS-8207 or electronically generated ePASS application). The form must be signed by an adult household member (or an authorized representative), and NC FAST captures the user ID which serves as the worker’s electronic signature. Additionally, employment program participation is required for specified applicants. Eligibility criteria further outlined in Food and Nutrition Services Certification Manual, Section 305 through Section 350. Condition: There were Seven (7) cases lacking the required signature or date certifying the documentation, Twelve (12) cases in which the proper documentation was not provided for the client, Six (6) cases of NC FAST evidence input error, and Three (3) cases of incomplete or incorrect income verifications. Questioned Costs: While there was an affect to eligibility, there were no questioned costs. Context: We examined 60 out of 3,761 Food and Nutrition Services case files active during the fiscal year to ensure verifications used to determine eligibility were properly documented. Effect: For the active cases, there was a chance that information was not adequately documented or were not accessible NC FAST which affect general adherence to prescribed guidelines. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2024-003. 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 supporting documentation used for eligibility verification be reviewed for completeness and reconciled to the information provided in worker dictation. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.
Criteria: Temporary Assistance for Needy Families - Work First Program case files require proper documentation be contained in the case record to verify eligibility, along with continued compliance to additional requirements set forth through federal and state guidance and specified requirements set forth in the Lenoir County Work First Electing County Plan. The case file should contain a completed, signed (telephonic signature is allowable) and dated standardized forms, including application and others. Additionally, employment program participation is required for specified applicants. Eligibility criteria further outlined in the Work First Policy Manual and the Lenoir County Work First Electing County Plan (2023 - 2025). Condition: There were Two (2) instances of missing or incomplete income verifications, One (1) instance of missing application documentation, Two (2) instances of missing required forms, One (1) instance of errors within the NC FAST time period recording that were not addressed, Three (3) instances of evidence being entered incorrectly into NC FAST, Two (2) instances of missing residency verifications, Two (2) instance of missing or incorrect kinship verifications, Two (2) instances of unenforced or noncompliance with child support enforcement, and One (1) instance of missing or incomplete documentation of work services compliance. Also, some specifications detailed in the Lenoir County Work First Electing County Plan were not enforced in any cases reviewed. Questioned Costs: While there was an affect to eligibility, there were no questioned costs. Context: We examined 25 out of 240 TANF - Work First case files active during the fiscal year to ensure verifications used to determine eligibility were properly documented. Effect: For the active cases, there was a chance that information was not adequately documented or were not accessible NC FAST which affect general adherence to prescribed guidelines. Identification of a repeat finding: This is not a repeat finding. 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 supporting documentation used for eligibility verification be reviewed for completeness and reconciled to the information provided in worker dictation. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.