Finding 1153771 (2024-004)

Reference: 2024-004 U.S. Department of Agriculture Pass-through entities: NYS Department of Health Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) 10.557 Onondaga County Department of Health Program Year: 2024 Criteria: A competent professional authority, CPA must determine that the applicant is at nutritional risk. At minimum, the CPA must perform and/or document measurements of each applicant’s height or length and weight. In addition, a hematological test for anemia must be performed and documented at certification. Additionally, the determination of nutritional risk factor must be based on the current referral data provided by a competent professional authority who is not on the WIC staff. (7 CFR sections 246.2 & 246.7(e)) Internal controls should provide reasonable assurance that the County complies with activities allowed or unallowed and eligibility requirements according to the Uniform Guidance. Reference: 2024-004 (Continued) Cause/Condition: The County’s current policies and procedures are not operating effectively to ensure that only eligible recipients are receiving payments. Specifically, the following deficiencies in internal control over compliance were identified: • In 5 of 40 cases, there is no documentation of height or length and weight measurements and/or no documentation of hematological testing. No indication of providing client a Medical Referral form to obtain the information. Nutritional risk could not be assessed accurately. • In 9 of 40 cases, verbal height and weight measurements were documented at certification, however, documentation of medical referral does not appear to be sent until subsequent follow-up appointments. This is a repeat of the finding in the prior fiscal year's audit report, 2023-003. Effect: Existing internal controls were not operating properly to ensure compliance with eligibility according to Uniform Guidance. Context: A sample of 40 cases was selected for audit from a population of greater than 200. Our sample was a statistically valid sample. Recommendation: We recommend that the County create or reinforce existing policies and procedures that require completion and review of the case files to ensure proper documentation related to the eligibility determination. Questioned Costs: None noted. Management’s Response: The County agrees with the findings and will reinforce existing policies and procedures within the Health Department to ensure that all supporting documents are properly obtained.