FAC Explorer

Finding 1092279 (2024-002)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2024
Accepted
2024-12-19
Audit: 333693
Organization: Anson County (NC)
Auditor: Thompson Price Scott Adams & CO

AI Summary

  • Core Issue: There were errors in documenting eligibility for Medicaid benefits, risking approvals for ineligible applicants.
  • Impacted Requirements: Compliance with 42 CFR 435 was not met, as necessary documentation for eligibility determinations was either missing or requested late.
  • Recommended Follow-Up: Conduct internal reviews of files, retrain staff on documentation standards, and ensure all eligibility files include necessary verifications and clear case notes.

Finding Text

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: 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 applicants could have been approved for benefits for which they were not eligible. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 373,631 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Program Names: Medical Assistance AL # 93.778 Finding: 2024-002 Inadequate Request for Information 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 6 errors discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. Questioned Costs: 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 and 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-005. Section III - Federal Award Findings and Questioned Costs Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. See corrective action plan.

Categories

Eligibility Significant Deficiency

Other Findings in this Audit

  • 515837 2024-002
    Significant Deficiency Repeat
  • 515838 2024-003
    Significant Deficiency Repeat
  • 515839 2024-004
    Significant Deficiency Repeat
  • 515840 2024-005
    Significant Deficiency Repeat
  • 515841 2024-006
    Significant Deficiency Repeat
  • 1092280 2024-003
    Significant Deficiency Repeat
  • 1092281 2024-004
    Significant Deficiency Repeat
  • 1092282 2024-005
    Significant Deficiency Repeat
  • 1092283 2024-006
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
66.458 Clean Water State Revolving Fund $4.93M
20.526 Buses and Bus Facilities Formula, Competitive, and Low Or No Emissions Programs $2.02M
93.778 Medical Assistance Program $1.16M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $425,438
93.563 Child Support Services $312,061
21.027 Coronavirus State and Local Fiscal Recovery Funds $239,252
20.509 Formula Grants for Rural Areas and Tribal Transit Program $173,535
93.967 Centers for Disease Control and Prevention Collaboration with Academia to Strengthen Public Health $171,718
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $160,401
93.558 Temporary Assistance for Needy Families $156,755
93.568 Low-Income Home Energy Assistance $113,598
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $97,670
93.767 Children's Health Insurance Program $96,537
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $89,753
93.667 Social Services Block Grant $88,674
93.695 Health Equity Data Access Program $84,098
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $56,464
21.032 Local Assistance and Tribal Consistency Fund $50,000
20.106 Airport Improvement Program, Covid-19 Airports Programs, and Infrastructure Investment and Jobs Act Programs $47,220
93.217 Family Planning Services $40,683
93.052 National Family Caregiver Support, Title Iii, Part E $39,563
93.658 Foster Care Title IV-E $39,562
93.268 Immunization Cooperative Agreements $37,400
93.069 Public Health Emergency Preparedness $31,969
93.994 Maternal and Child Health Services Block Grant to the States $21,649
20.703 Interagency Hazardous Materials Public Sector Training and Planning Grants $10,000
93.053 Nutrition Services Incentive Program $8,098
93.991 Preventive Health and Health Services Block Grant $4,958
93.645 Stephanie Tubbs Jones Child Welfare Services Program $4,566
97.042 Emergency Management Performance Grants $4,419
93.917 Hiv Care Formula Grants $2,330
93.043 Special Programs for the Aging, Title Iii, Part D, Disease Prevention and Health Promotion Services $850
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $100
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $50