FAC Explorer

Finding 1095068 (2024-002)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2024
Accepted
2025-01-10
Audit: 337085
Organization: Person County (NC)
Auditor: Thompson Price Scott Adams & CO

AI Summary

  • Core Issue: Inaccurate information was entered during eligibility determinations for Medicaid, leading to significant deficiencies in record keeping.
  • Impacted Requirements: Compliance with 42 CFR 435 and 2 CFR 200 is necessary for maintaining proper documentation and internal controls for eligibility determinations.
  • Recommended Follow-up: Conduct internal reviews of files, retrain workers on documentation standards, and ensure all files include necessary verifications and clear case notes.

Finding Text

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-002 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: There were 5 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Section III. Federal Award Findings and Questioned Costs Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. 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. There was no known affect to eligibility and there were no known questioned costs. 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. We examined 60 cases from of a total of 454,445 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. This is a repeat finding from the immediate previous audit, 2023-001. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible.

Categories

Eligibility Internal Control / Segregation of Duties

Other Findings in this Audit

  • 518626 2024-002
    Significant Deficiency Repeat
  • 518627 2024-003
    Significant Deficiency Repeat
  • 518628 2024-004
    Significant Deficiency Repeat
  • 518629 2024-005
    Significant Deficiency Repeat
  • 518630 2024-006
    Significant Deficiency
  • 1095069 2024-003
    Significant Deficiency Repeat
  • 1095070 2024-004
    Significant Deficiency Repeat
  • 1095071 2024-005
    Significant Deficiency Repeat
  • 1095072 2024-006
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $1.81M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $816,659
93.658 Foster Care Title IV-E $606,445
93.563 Child Support Services $547,524
93.667 Social Services Block Grant $373,797
93.558 Temporary Assistance for Needy Families $275,869
20.509 Formula Grants for Rural Areas and Tribal Transit Program $224,988
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $218,810
16.922 Equitable Sharing Program $147,247
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $133,449
93.767 Children's Health Insurance Program $118,228
93.268 Immunization Cooperative Agreements $97,541
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $92,365
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $86,155
97.137 State and Local Cybersecurity Grant Program Tribal Cybersecurity Grant Program $77,780
93.217 Family Planning Services $46,450
93.568 Low-Income Home Energy Assistance $45,288
93.069 Public Health Emergency Preparedness $31,668
93.991 Preventive Health and Health Services Block Grant $30,431
16.607 Bulletproof Vest Partnership Program $25,503
16.738 Edward Byrne Memorial Justice Assistance Grant Program $23,519
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $18,243
93.645 Stephanie Tubbs Jones Child Welfare Services Program $11,283
93.053 Nutrition Services Incentive Program $11,136
93.659 Adoption Assistance $3,920
21.027 Coronavirus State and Local Fiscal Recovery Funds $3,509
93.994 Maternal and Child Health Services Block Grant to the States $2,562
93.042 Special Programs for the Aging, Title Vii, Chapter 2, Long Term Care Ombudsman Services for Older Individuals $1,376
93.052 National Family Caregiver Support, Title Iii, Part E $1,050
93.917 Hiv Care Formula Grants $594
93.556 Marylee Allen Promoting Safe and Stable Families Program $116
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $100
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $50