Finding 2023-057
U.S. Department of Health and Human Services
Medicaid Cluster:
State Medicaid Fraud Control Units, 93.775
State Survey and Certification of Health Care Providers and Suppliers (Title XVIII) Medicare, 93.777
Medical Assistance Program (Medicaid; Title XIX), 93.778
Summary of Finding:...
Finding 2023-057
U.S. Department of Health and Human Services
Medicaid Cluster:
State Medicaid Fraud Control Units, 93.775
State Survey and Certification of Health Care Providers and Suppliers (Title XVIII) Medicare, 93.777
Medical Assistance Program (Medicaid; Title XIX), 93.778
Summary of Finding: Amounts reported on the CMS-64 were not supported by the underlying accounting information
DHCFP did not have adequate internal controls to ensure CMS-64 reports were accurate or supporting documentation for reconciling items was maintained.
Inaccurate information may be reported to the federal awarding agency.
DHCFP has manual adjustments to key line items within the CMS-64 from the general ledger. DHCFP did not maintain a record of any of the manual adjustments and we were unable to verify whether the manual adjustment was appropriate. In total, there were $36,128,957 in manual adjustments in the December 31, 2022 CMS-64 report and $5,364,337 in the March 31, 2023 CMS-64 report that we were unable to verify.
We recommend DHCFP enhance internal controls to ensure CMS-64 reports are accurate and supporting documentation is maintained.
NVHA Response: Nevada Health Authority agrees with this finding.
Corrected Action Planned:
The Division has enhanced its internal controls to ensure the accuracy of CMS-64 reports and the proper maintenance of supporting documentation. The following measures have been implemented:
1. System of Record – DAWN:
The state’s accounting system, DAWN, continues to serve as the Division’s official system of record for compiling CMS-64 reports.
2. Reduction of Manual Adjustments:
The Budget Unit and Federal Reporting Units are proactively working to reduce the number of manual adjustments by creating journal vouchers (JVs) to account for transactions that would otherwise be processed manually.
3. Documentation of Manual Transactions:
For manual transactions that cannot be incorporated into DAWN, the Federal Reporting Unit has added explanatory notes in the backup workpapers.
4. Reporting Requirements for Certain Service Costs:
Currently, several service costs are commingled within MMIS. To address this, the Division performs data downloads from MMIS to separate and identify these costs appropriately for CMS-64 reporting. The Federal Reporting Unit will ensure these MMIS reports are maintained to provide transparency and traceability.
5. Collaboration with Fiscal Agent:
The Division is actively collaborating with its Fiscal Agent, Gainwell, to improve CMS-64 reporting. This includes the development of new “fiscal strings” designed to capture and isolate specific costs that must be reported separately. These efforts aim to enhance transparency and accuracy in federal reporting.
These improvements reflect the Division’s commitment to strengthening financial reporting processes, ensuring compliance with federal requirements, and maintaining robust documentation standards.
Anticipated Completion Date of Corrective Action Plan: September 2025