FAC Explorer

Finding 1096516 (2024-001)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2025-01-23
Audit: 339573
Organization: Wilson County, North Carolina (NC)
Auditor: Martin Starnes & Associates CPAS P A

AI Summary

  • Core Issue: Inadequate documentation for a claim entered into the EPI system, leading to potential inaccuracies.
  • Impacted Requirements: Counties must maintain sufficient case documentation as per the North Carolina DSS Crosscutting Requirements.
  • Recommended Follow-Up: Implement controls to ensure all documentation is accurate and aligns with EPI entries.

Finding Text

U.S. Department of Health and Human Services Passed through the N.C. Department of Health and Human Services, Division of Social Services Program Name: DSS Crosscutting (State) Medicaid Cluster AL#93.778 (XIX-MAP24) Finding: 2024-001 Significant Deficiency, non-material non-compliance Special Tests and Provisions (Enterprise Program Integrity) Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment. Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County. Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile. Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result. Cause: Documentation to support a claim entered into EPI was not accurate. Questioned Costs: None, no payments have been collected by the County to date on this claim. Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI. Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.

Categories

Special Tests & Provisions Significant Deficiency

Other Findings in this Audit

  • 520070 2024-001
    Significant Deficiency
  • 520071 2024-001
    Significant Deficiency
  • 520072 2024-001
    Significant Deficiency
  • 520073 2024-001
    Significant Deficiency
  • 520074 2024-001
    Significant Deficiency
  • 520075 2024-001
    Significant Deficiency
  • 1096512 2024-001
    Significant Deficiency
  • 1096513 2024-001
    Significant Deficiency
  • 1096514 2024-001
    Significant Deficiency
  • 1096515 2024-001
    Significant Deficiency
  • 1096517 2024-001
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program - Medical Assistance Administration $3.94M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program - Admin $2.08M
93.563 Child Support Enforcement Title IV-D Administration $1.41M
93.658 Foster Care Title IV-E $566,317
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children - Administration $528,955
93.778 Medical Assistance Program - Ma Expansion $461,617
93.558 Temporary Assistance for Needy Families (tanf) - Work First Admin $448,621
93.667 Social Services Block Grant - Other Service and Training $448,035
14.228 Covid-19 - Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $381,993
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund - Admin $327,136
20.509 Formula Grants for Rural Areas and Tribal Transit Program - Capital I $295,255
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program - Fraud Admin $286,347
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $245,397
93.767 Children's Health Insurance Program: Nc Health Choice - Admin $205,570
93.778 Medical Assistance Program - Medical Transportation Administration $205,400
21.027 Covid-19 - Coronavirus State and Local Fiscal Recovery Funds $199,737
20.509 Covid- 19 - Formula Grants for Rural Areas and Tribal Transit Program $107,642
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program - Food Stamp E&t & Depend C $101,851
93.568 Low-Income Home Energy Assistance - Admin & Assistance $101,385
93.778 Medical Assistance Program - Medical Transportation Service $101,104
93.994 Maternal and Child Health Services Block Grant to the States $100,237
45.310 Grants to States - Lsta Ez Grants $100,000
93.658 Foster Care Title IV-E - Direct Benefit Payments $99,531
97.137 State and Local Cybersecurity Grant Program $88,407
20.509 Formula Grants for Rural Areas and Tribal Transit Program - Administrative Assistance $87,193
93.048 Covid-19 - Special Programs for the Aging, Title Iv, and Title Ii, Discretionary Projects Covid-19 and Influenza Vaccine Uptake Initiative $85,087
93.778 Medical Assistance Program - State County Special Assistance $79,289
93.217 Family Planning Services $71,266
93.563 Child Support Enforcement IV-D Incentives $66,223
93.590 Community-Based Child Abuse Prevention Grants $66,048
93.667 Social Services Block Grant - State Adult Day Care $59,869
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $56,054
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $45,000
93.778 Medical Assistance Program - Adult Care Home Case Management $44,968
93.659 Adoption Assistance $42,171
93.268 Immunization Cooperative Agreements $41,778
10.561 Covid-19 - State Administrative Matching Grants for the Supplemental Nutrition Assistance Program - Fns Arpa Funds $40,425
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $38,904
93.667 Social Services Block Grant $37,422
93.268 Covid-19 - Immunization Cooperative Agreements $35,800
93.053 Nutrition Services Incentive Program $32,640
93.991 Preventive Health and Health Services Block Grant $29,914
16.606 State Criminal Alien Assistance Program $26,921
93.667 Social Services Block Grant - State in Home Service Fund $24,128
93.558 Temporary Assistance for Needy Families $19,584
93.556 Marylee Allen Promoting Safe and Stable Families Program $19,137
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $17,895
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $17,600
93.069 Public Health Emergency Preparedness $16,307
97.042 Emergency Management Performance Grants $15,319
93.917 Hiv Care Formula Grants - Ryan White Care Act $11,512
93.568 Covid-19 - Low-Income Home Energy Assistance - Arpa Admin $7,404
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood - Administration $7,238
93.645 Stephanie Tubbs Jones Child Welfare Services Program $4,667
93.667 Covid-19 - Social Services Block Grant - State Adult Day Care Arpa $4,600
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood - Direct Benefit Payments $4,050
93.110 Maternal and Child Health Federal Consolidated Programs $3,992
93.568 Low-Income Home Energy Assistance - Crisis Intervention Payments $3,930
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $100