Finding 1100815 (2024-007)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2024
Accepted
2025-02-24
Audit: 343605
Organization: Richmond County (NC)

AI Summary

  • Core Issue: Richmond County has repeat findings related to inaccurate resource entries and inadequate requests for information in Medicaid eligibility determinations.
  • Impacted Requirements: Compliance with 42 CFR 435 and Medicaid Manual MA-2230, which mandate proper documentation and verification for eligibility assessments.
  • Recommended Follow-Up: Conduct internal reviews of case files to ensure accurate calculations and complete documentation, and implement corrective actions as outlined in the County's plan.

Finding Text

Richmond County Schedule of Findings and Questioned Costs For The Year Ended June 30, 2024 Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: U.S. 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: 2024-007 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: This is a repeat finding from the immediate previous audit, 2023-006. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 826,901 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 toRichmond County Schedule of Findings and Questioned Costs For The Year Ended June 30, 2024 Recommendation: Views of responsible officials and planned corrective actions: U.S. 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: 2024-008 Inadequate Request for Information SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: We examined 60 cases from of a total of 826,901 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, 2023-007. 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. Section III - Federal Award Findings and Questioned Costs (continued) Case files should be reviewed internally to ensure correct calculations of resources are made, proper information is included in the case file, and necessary procedures are taken when determining eligibility. 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. See Corrective Action Plan in the following section. 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 all required verifications have been completed and information requested from the applicant/beneficiary or through various systems have been included and necessary procedures are taken when determining eligibility. 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. See Corrective Action Plan in the following section. 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 2 errors discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. There was no known affect to eligibility and there were no known questioned costs. 136 NC FAST and a participant could have been approved for benefits for which they were not eligible. 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 correct income and/or household size calculations, proper information is included in the case file, and necessary procedures are taken when determining eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. This is a repeat finding from the immediate previous audit, 2023-005. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. Section III - Federal Award Findings and Questioned Costs (continued) The County agrees with the finding. See Corrective Action Plan in the following section. 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 were 6 errors discovered during our procedures where resources were incorrectly calculated or were not properly documented in the case file. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 826,901 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. 135

Categories

Eligibility

Other Findings in this Audit

  • 524371 2024-005
    Significant Deficiency Repeat
  • 524372 2024-006
    Significant Deficiency Repeat
  • 524373 2024-007
    Significant Deficiency Repeat
  • 524374 2024-008
    Significant Deficiency Repeat
  • 524375 2024-009
    Significant Deficiency
  • 1100813 2024-005
    Significant Deficiency Repeat
  • 1100814 2024-006
    Significant Deficiency Repeat
  • 1100816 2024-008
    Significant Deficiency Repeat
  • 1100817 2024-009
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
21.027 Coronavirus State and Local Fiscal Recovery Funds $2.22M
93.778 Medical Assistance Program $1.48M
93.658 Foster Care Title IV-E $933,423
93.563 Child Support Services $784,303
93.558 Temporary Assistance for Needy Families $689,349
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $663,074
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $459,417
93.667 Social Services Block Grant $291,958
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $250,362
93.568 Low-Income Home Energy Assistance $146,176
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $127,307
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $122,505
93.268 Immunization Cooperative Agreements $69,305
93.767 Children's Health Insurance Program $65,075
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $60,392
93.994 Maternal and Child Health Services Block Grant to the States $52,739
93.217 Family Planning Services $47,380
93.967 Centers for Disease Control and Prevention Collaboration with Academia to Strengthen Public Health $44,935
97.042 Emergency Management Performance Grants $39,698
93.069 Public Health Emergency Preparedness $34,799
93.053 Nutrition Services Incentive Program $31,679
93.991 Preventive Health and Health Services Block Grant $30,431
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $20,843
20.106 Airport Improvement Program, Infrastructure Investment and Jobs Act Programs, and Covid-19 Airports Programs $20,542
93.556 Marylee Allen Promoting Safe and Stable Families Program $13,277
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $9,500
93.645 Stephanie Tubbs Jones Child Welfare Services Program $7,423
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $5,470
93.659 Adoption Assistance $4,439
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $3,000
93.110 Maternal and Child Health Federal Consolidated Programs $2,000
93.917 Hiv Care Formula Grants $789
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $100
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $14