Finding 1055164 (2023-008)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2024-07-17
Audit: 315389
Organization: Hyde County (NC)

AI Summary

  • Core Issue: There are repeated errors in resource calculations and documentation for Medicaid eligibility, leading to discrepancies between county records and the NC FAST system.
  • Impacted Requirements: Compliance with Medicaid Manual MA-2230 and 42 CFR 435 is lacking, particularly in record-keeping and verification processes.
  • Recommended Follow-Up: Implement internal reviews and retrain staff on proper documentation practices to ensure accurate eligibility determinations and compliance with regulations.

Finding Text

Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Identification of a repeat finding: In accordance with Medicaid Manual MA-2230, 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 noncountable resources and explained within the documentation. There was no known affect to eligibility and there were no known questioned costs. Inaccurate Resource Calculation Section III - Federal Award Findings and Questioned Costs (continued) Finding: 2023-008 SIGNIFICANT DEFICIENCY Questioned Costs: This is a repeat finding from the immediate previous audit, 2022-010. There were 8 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. We examined 60 cases from of a total of 40,658 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. The county agrees with the finding. Please refer to the corrective action plan for details. Cause: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program AL #: 93.778 Eligibility Criteria: Condition: Context: Effect: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials: 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. The county agrees with the finding. Please refer to the corrective action plan for details. Section III - Federal Award Findings and Questioned Costs (continued) Recommendation: We examined 60 cases from of a total of 40,658 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. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Finding: 2023-009 Inadequate Request for Information SIGNIFICANT DEFICIENCY 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. There were 20 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.

Categories

Eligibility Significant Deficiency

Other Findings in this Audit

  • 478721 2023-007
    Significant Deficiency Repeat
  • 478722 2023-008
    Significant Deficiency Repeat
  • 478723 2023-009
    Significant Deficiency Repeat
  • 1055163 2023-007
    Significant Deficiency Repeat
  • 1055165 2023-009
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
21.027 Coronavirus State and Local Fiscal Recovery Funds $709,805
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $432,257
93.778 Medical Assistance Program $347,796
97.039 Hazard Mitigation Grant $190,575
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $126,863
93.563 Child Support Enforcement $100,607
93.658 Foster Care_title IV-E $100,225
93.268 Immunization Cooperative Agreements $86,117
93.568 Low-Income Home Energy Assistance $74,742
93.667 Social Services Block Grant $67,561
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $58,768
93.558 Temporary Assistance for Needy Families $43,605
97.042 Emergency Management Performance Grants $38,147
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $36,732
93.217 Family Planning_services $26,043
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $25,858
93.991 Preventive Health and Health Services Block Grant $24,796
93.069 Public Health Emergency Preparedness $19,812
20.106 Airport Improvement Program $17,607
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $13,573
93.994 Maternal and Child Health Services Block Grant to the States $11,978
20.513 Enhanced Mobility of Seniors and Individuals with Disabilities $10,545
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $7,911
93.767 Children's Health Insurance Program $7,221
93.053 Nutrition Services Incentive Program $5,571
93.556 Promoting Safe and Stable Families $4,800
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $4,290
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $2,799
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $855
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $566
93.645 Stephanie Tubbs Jones Child Welfare Services Program $452