FAC Explorer

Finding 1161244 (2022-037)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
$1
Year
2022
Accepted
2025-10-22
Audit: 371187
Organization: Commonwealth of the Northern Mariana Islands (MP)
Auditor: ERNST & YOUNG (CNMI) INC

AI Summary

  • Core Issue: CNMI failed to verify service providers against the HHS OIG exclusion list, leading to noncompliance and questioned costs of $7,932,110.
  • Impacted Requirements: Providers barred by HHS OIG are ineligible for CHIP enrollment; routine checks of federal databases are mandatory.
  • Recommended Follow-Up: CNMI should implement monitoring controls for provider verification and stay updated on federal regulations affecting the program.

Finding Text

Finding No. 2022-037 Federal Agency: U.S. Department of Health and Human Services AL Program: 93.767 Children’s Health Insurance Program Federal Award No.: 7510515 & 7520515 Area: Special Tests and Provisions - Provider Eligibility (Screening and Enrollment) Questioned Costs: $7,932,110 Criteria: Providers who have been barred from participation by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) exclusion list are not eligible to be enrolled in the CHIP program (42 CFR 457.990, 42 CFR 455 Subpart E). Accordingly, in accordance with 42 Section 455.436 of Subpart E, the State Medicaid agency must do the following: a. Confirm the identity and determine the exclusion status of providers and any person with an ownership or control interest or who is an agent or managing employee of the provider through routine checks of Federal databases; b. Check the Social Security Administration's Death Master File, the National Plan and Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE), the Excluded Parties List System (EPLS), and any such other databases as the Secretary may prescribe; c. Consult appropriate databases to confirm identity upon enrollment and reenrollment; and d. Check the LEIE and EPLS no less frequently than monthly. Condition: For sixteen (or 100%), service providers tested, no procedures were performed to verify whether the providers are on the OIG exclusion list. No questioned costs are presented for Provider Number IR-117 as there were no payments made to the provider during FY2022. Cause: CNMI was not aware of the HHS OIG exclusion verification requirement, including the availability of the HHS OIG exclusion listing within the CMS Portal until subsequent to FY2022. Effect: The CNMI is in noncompliance with the applicable Special Tests and Provisions - Provider Eligibility and questioned costs of $7,932,110 result. Recommendation: 1. CNMI should establish and implement monitoring control procedures to ensure service providers are verified against the HHS OIG exclusion listing, prior to entering into or renewing service provider agreements; and 2. Responsible CNMI personnel should periodically monitor updates in federal regulations affecting the program. Views of Responsible Officials: CNMI Medicaid Office disagrees with the finding. While the office did perform OIG exclusion list validation, screenshots were not captured for each individual check. It is important to note that the OIG Exclusion List portal’s search function is limited to on-screen viewing and does not provide a built-in option to print or export search results. Refer to CNMI’s Corrective Action Plan for additional information. Auditor Response: Per discussion with program personnel, verification of service providers from the OIG exclusion list were not performed during FY2022, as the CNMI Medicaid Office was not aware of the HHS OIG exclusion verification requirement until subsequently to FY2022, for which is when the authorized program personnel gained access to the HHS OIG exclusion list within the CMS Portal.

Corrective Action Plan

Finding No.: 2022-037 AL Program: 93.767 - Children’s Health Insurance Program Area: Special Tests and Provisions - Provider Eligibility (Screening and Enrollment) Questioned Costs: $7,932,110 Contact Person(s): Geroge J. Cruz, Medicaid Director Corrective Action Plan: CNMI Medicaid Office respectfully disagrees with the finding. While the office did perform OIG exclusion list validation, screenshots were not captured for each individual check. It is important to note that the OIG Exclusion List portal’s search function is limited to on-screen viewing and does not provide a built-in option to print or export search results. Additionally, the CMS access process for exclusion checks involves a rigorous background clearance, and only one personnel of three total successfully gained access. CNMI Medicaid Office acknowledges that historically, limited personnel capacity has hindered full compliance with this requirement. However, efforts are currently underway to streamline and strengthen the exclusion verification process. The office is actively developing a fully functional Program Integrity Division that will be responsible for conducting and documenting OIG exclusion checks in a consistent and compliant manner moving forward. Proposed Completion Date: Ongoing

Categories

Questioned Costs Special Tests & Provisions Subrecipient Monitoring Eligibility

Other Findings in this Audit

  • 1161189 2022-010
    Material Weakness Repeat
  • 1161190 2022-010
    Material Weakness Repeat
  • 1161191 2022-011
    Material Weakness Repeat
  • 1161192 2022-012
    Material Weakness Repeat
  • 1161193 2022-013
    Material Weakness Repeat
  • 1161194 2022-014
    Material Weakness Repeat
  • 1161195 2022-015
    Material Weakness Repeat
  • 1161196 2022-016
    Material Weakness Repeat
  • 1161197 2022-017
    Material Weakness Repeat
  • 1161198 2022-018
    Material Weakness Repeat
  • 1161199 2022-019
    Material Weakness Repeat
  • 1161200 2022-013
    Material Weakness Repeat
  • 1161201 2022-014
    Material Weakness Repeat
  • 1161202 2022-015
    Material Weakness Repeat
  • 1161203 2022-016
    Material Weakness Repeat
  • 1161204 2022-017
    Material Weakness Repeat
  • 1161205 2022-018
    Material Weakness Repeat
  • 1161206 2022-019
    Material Weakness Repeat
  • 1161207 2022-013
    Material Weakness Repeat
  • 1161208 2022-014
    Material Weakness Repeat
  • 1161209 2022-015
    Material Weakness Repeat
  • 1161210 2022-016
    Material Weakness Repeat
  • 1161211 2022-017
    Material Weakness Repeat
  • 1161212 2022-018
    Material Weakness Repeat
  • 1161213 2022-019
    Material Weakness Repeat
  • 1161214 2022-013
    Material Weakness Repeat
  • 1161215 2022-014
    Material Weakness Repeat
  • 1161216 2022-015
    Material Weakness Repeat
  • 1161217 2022-016
    Material Weakness Repeat
  • 1161218 2022-017
    Material Weakness Repeat
  • 1161219 2022-018
    Material Weakness Repeat
  • 1161220 2022-019
    Material Weakness Repeat
  • 1161221 2022-020
    Material Weakness Repeat
  • 1161222 2022-021
    Material Weakness Repeat
  • 1161223 2022-022
    Material Weakness Repeat
  • 1161224 2022-023
    Material Weakness Repeat
  • 1161225 2022-024
    Material Weakness Repeat
  • 1161226 2022-025
    Material Weakness Repeat
  • 1161227 2022-026
    Material Weakness Repeat
  • 1161228 2022-027
    Material Weakness Repeat
  • 1161229 2022-028
    Material Weakness Repeat
  • 1161230 2022-029
    Material Weakness Repeat
  • 1161231 2022-030
    Material Weakness Repeat
  • 1161232 2022-031
    Material Weakness Repeat
  • 1161233 2022-032
    Material Weakness Repeat
  • 1161234 2022-033
    Material Weakness Repeat
  • 1161235 2022-032
    Material Weakness Repeat
  • 1161236 2022-033
    Material Weakness Repeat
  • 1161237 2022-032
    Material Weakness Repeat
  • 1161238 2022-033
    Material Weakness Repeat
  • 1161239 2022-032
    Material Weakness Repeat
  • 1161240 2022-033
    Material Weakness Repeat
  • 1161241 2022-034
    Material Weakness Repeat
  • 1161242 2022-035
    Material Weakness Repeat
  • 1161243 2022-036
    Material Weakness Repeat
  • 1161245 2022-038
    Material Weakness Repeat
  • 1161246 2022-039
    Material Weakness Repeat
  • 1161247 2022-040
    Material Weakness Repeat
  • 1161248 2022-041
    Material Weakness Repeat
  • 1161249 2022-038
    Material Weakness Repeat
  • 1161250 2022-039
    Material Weakness Repeat
  • 1161251 2022-040
    Material Weakness Repeat
  • 1161252 2022-041
    Material Weakness Repeat
  • 1161253 2022-042
    Material Weakness Repeat
  • 1161254 2022-043
    Material Weakness Repeat
  • 1161255 2022-044
    Material Weakness Repeat
  • 1161256 2022-042
    Material Weakness Repeat
  • 1161257 2022-043
    Material Weakness Repeat
  • 1161258 2022-044
    Material Weakness Repeat
  • 1161259 2022-045
    Material Weakness Repeat
  • 1161260 2022-046
    Material Weakness Repeat
  • 1161261 2022-047
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
21.027 CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY FUNDS $243.39M
17.225 UNEMPLOYMENT INSURANCE $49.29M
93.767 CHILDREN'S HEALTH INSURANCE PROGRAM $16.73M
21.023 EMERGENCY RENTAL ASSISTANCE PROGRAM $11.02M
10.542 PANDEMIC EBT FOOD BENEFITS $10.37M
97.030 COMMUNITY DISASTER LOANS $8.04M
93.575 CHILD CARE AND DEVELOPMENT BLOCK GRANT $7.82M
10.539 CNMI NUTRITION ASSISTANCE $7.49M
97.039 HAZARD MITIGATION GRANT $4.56M
21.026 HOMEOWNER ASSISTANCE FUND $4.16M
93.596 CHILD CARE MANDATORY AND MATCHING FUNDS OF THE CHILD CARE AND DEVELOPMENT FUND $2.73M
66.801 HAZARDOUS WASTE MANAGEMENT STATE PROGRAM SUPPORT $2.51M
97.036 DISASTER GRANTS - PUBLIC ASSISTANCE (PRESIDENTIALLY DECLARED DISASTERS) $2.44M
66.600 ENVIRONMENTAL PROTECTION CONSOLIDATED GRANTS FOR THE INSULAR AREAS - PROGRAM SUPPORT $2.34M
12.617 ECONOMIC ADJUSTMENT ASSISTANCE FOR STATE GOVERNMENTS $1.85M
20.526 BUSES AND BUS FACILITIES FORMULA, COMPETITIVE, AND LOW OR NO EMISSIONS PROGRAMS $1.74M
11.307 ECONOMIC ADJUSTMENT ASSISTANCE $1.39M
15.605 SPORT FISH RESTORATION $1.32M
15.611 WILDLIFE RESTORATION AND BASIC HUNTER EDUCATION AND SAFETY $1.28M
93.489 CHILD CARE DISASTER RELIEF $1.24M
20.509 FORMULA GRANTS FOR RURAL AREAS AND TRIBAL TRANSIT PROGRAM $1.19M
11.419 COASTAL ZONE MANAGEMENT ADMINISTRATION AWARDS $954,712
93.045 SPECIAL PROGRAMS FOR THE AGING, TITLE III, PART C, NUTRITION SERVICES $830,622
97.067 HOMELAND SECURITY GRANT PROGRAM $781,287
97.U01 FEMA-JFO/DRC-Guard Services $661,485
20.600 STATE AND COMMUNITY HIGHWAY SAFETY $644,809
84.126 REHABILITATION SERVICES VOCATIONAL REHABILITATION GRANTS TO STATES $625,444
97.012 BOATING SAFETY FINANCIAL ASSISTANCE $600,225
15.875 ECONOMIC, SOCIAL, AND POLITICAL DEVELOPMENT OF THE TERRITORIES $582,229
93.569 COMMUNITY SERVICES BLOCK GRANT $555,046
93.558 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES $481,476
15.615 COOPERATIVE ENDANGERED SPECIES CONSERVATION FUND $474,763
93.044 SPECIAL PROGRAMS FOR THE AGING, TITLE III, PART B, GRANTS FOR SUPPORTIVE SERVICES AND SENIOR CENTERS $452,548
17.277 WIOA NATIONAL DISLOCATED WORKER GRANTS / WIA NATIONAL EMERGENCY GRANTS $444,555
16.034 CORONAVIRUS EMERGENCY SUPPLEMENTAL FUNDING PROGRAM $442,103
16.575 CRIME VICTIM ASSISTANCE $417,507
10.025 PLANT AND ANIMAL DISEASE, PEST CONTROL, AND ANIMAL CARE $409,547
11.482 CORAL REEF CONSERVATION PROGRAM $404,632
17.258 WIOA ADULT PROGRAM $382,903
16.588 VIOLENCE AGAINST WOMEN FORMULA GRANTS $368,487
17.278 WIOA DISLOCATED WORKER FORMULA GRANTS $360,286
15.634 STATE WILDLIFE GRANTS $333,981
17.259 WIOA YOUTH ACTIVITIES $333,058
93.778 MEDICAL ASSISTANCE PROGRAM $318,867
93.434 EVERY STUDENT SUCCEEDS ACT/PRESCHOOL DEVELOPMENT GRANTS $287,347
16.710 PUBLIC SAFETY PARTNERSHIP AND COMMUNITY POLICING GRANTS $282,833
81.041 STATE ENERGY PROGRAM $281,655
81.042 WEATHERIZATION ASSISTANCE FOR LOW-INCOME PERSONS $278,491
10.649 PANDEMIC EBT ADMINISTRATIVE COSTS $258,116
20.218 MOTOR CARRIER SAFETY ASSISTANCE $246,279
12.600 COMMUNITY INVESTMENT $242,221
93.556 MARYLEE ALLEN PROMOTING SAFE AND STABLE FAMILIES PROGRAM $238,819
17.504 CONSULTATION AGREEMENTS $234,374
97.062 SCIENTIFIC LEADERSHIP AWARDS $216,694
17.235 SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM $207,151
15.904 HISTORIC PRESERVATION FUND GRANTS-IN-AID $185,830
64.203 VETERANS CEMETERY GRANTS PROGRAM $175,658
15.663 NFWF-USFWS CONSERVATION PARTNERSHIP $160,217
12.022 DOD MENTOR-PROTEGE PROGRAM $160,121
45.310 GRANTS TO STATES $156,947
16.738 EDWARD BYRNE MEMORIAL JUSTICE ASSISTANCE GRANT PROGRAM $148,552
93.671 FAMILY VIOLENCE PREVENTION AND SERVICES/DOMESTIC VIOLENCE SHELTER AND SUPPORTIVE SERVICES $143,315
16.750 SUPPORT FOR ADAM WALSH ACT IMPLEMENTATION GRANT PROGRAM $135,657
93.590 COMMUNITY-BASED CHILD ABUSE PREVENTION GRANTS $135,591
93.568 LOW-INCOME HOME ENERGY ASSISTANCE $118,439
97.047 BRIC: BUILDING RESILIENT INFRASTRUCTURE AND COMMUNITIES $112,435
11.472 UNALLIED SCIENCE PROGRAM $112,262
93.464 ACL ASSISTIVE TECHNOLOGY $111,566
17.285 REGISTERED APPRENTICESHIP $104,348
93.645 STEPHANIE TUBBS JONES CHILD WELFARE SERVICES PROGRAM $103,317
59.061 STATE TRADE EXPANSION $99,650
10.170 SPECIALTY CROP BLOCK GRANT PROGRAM - FARM BILL $98,021
11.437 PACIFIC FISHERIES DATA PROGRAM $93,960
97.042 EMERGENCY MANAGEMENT PERFORMANCE GRANTS $83,128
45.025 PROMOTION OF THE ARTS PARTNERSHIP AGREEMENTS $79,513
10.664 COOPERATIVE FORESTRY ASSISTANCE $78,427
93.053 NUTRITION SERVICES INCENTIVE PROGRAM $73,223
97.U03 FEMA-IGSA Enhdisasterlegalserv $70,131
11.467 METEOROLOGIC AND HYDROLOGIC MODERNIZATION DEVELOPMENT $64,229
93.048 SPECIAL PROGRAMS FOR THE AGING, TITLE IV, AND TITLE II, DISCRETIONARY PROJECTS $62,557
21.029 CORONAVIRUS CAPITAL PROJECTS FUND $59,975
16.017 SEXUAL ASSAULT SERVICES FORMULA PROGRAM $59,393
10.680 FOREST HEALTH PROTECTION $56,252
97.050 PRESIDENTIAL DECLARED DISASTER ASSISTANCE TO INDIVIDUALS AND HOUSEHOLDS - OTHER NEEDS $44,486
93.747 ELDER ABUSE PREVENTION INTERVENTIONS PROGRAM $42,583
97.008 NON-PROFIT SECURITY PROGRAM $40,698
93.499 LOW INCOME HOUSEHOLD WATER ASSISTANCE PROGRAM $40,185
10.179 MICRO-GRANTS FOR FOOD SECURITY PROGRAM $39,793
93.667 SOCIAL SERVICES BLOCK GRANT $38,860
93.052 NATIONAL FAMILY CAREGIVER SUPPORT, TITLE III, PART E $37,209
16.585 TREATMENT COURT DISCRETIONARY GRANT PROGRAM $36,068
97.U02 FEMA Cost Share For Tinian $34,834
20.703 INTERAGENCY HAZARDOUS MATERIALS PUBLIC SECTOR TRAINING AND PLANNING GRANTS $31,544
90.404 HAVA ELECTION SECURITY GRANTS $30,376
17.273 TEMPORARY LABOR CERTIFICATION FOR FOREIGN WORKERS $29,237
10.766 COMMUNITY FACILITIES LOANS AND GRANTS $27,077
12.300 BASIC AND APPLIED SCIENTIFIC RESEARCH $21,582
93.369 ACL INDEPENDENT LIVING STATE GRANTS $21,096
45.129 PROMOTION OF THE HUMANITIES FEDERAL/STATE PARTNERSHIP $19,840
93.643 CHILDREN'S JUSTICE GRANTS TO STATES $18,435
84.177 REHABILITATION SERVICES INDEPENDENT LIVING SERVICES FOR OLDER INDIVIDUALS WHO ARE BLIND $18,377
66.040 DIESEL EMISSIONS REDUCTION ACT (DERA) STATE GRANTS $17,137
12.113 STATE MEMORANDUM OF AGREEMENT PROGRAM FOR THE REIMBURSEMENT OF TECHNICAL SERVICES $16,417
20.100 AVIATION EDUCATION $14,689
93.669 CHILD ABUSE AND NEGLECT STATE GRANTS $14,311
93.450 EBOLA HEALTHCARE PREPAREDNESS AND RESPONSE FOR SELECT CITIES WITH ENHANCED AIRPORT ENTRANCE SCREENINGS FROM AFFECTED COUNTRIES IN WEST AFRICA $13,717
93.043 SPECIAL PROGRAMS FOR THE AGING, TITLE III, PART D, DISEASE PREVENTION AND HEALTH PROMOTION SERVICES $13,076
20.205 HIGHWAY PLANNING AND CONSTRUCTION $12,910
93.630 DEVELOPMENTAL DISABILITIES BASIC SUPPORT AND ADVOCACY GRANTS $11,986
10.U01 DLNR CNMI Fisheries Training $8,033
93.042 SPECIAL PROGRAMS FOR THE AGING, TITLE VII, CHAPTER 2, LONG TERM CARE OMBUDSMAN SERVICES FOR OLDER INDIVIDUALS $7,552
19.976 International Narcotics Control and Law Enforcement $6,973
21.019 CORONAVIRUS RELIEF FUND $5,204
11.454 UNALLIED MANAGEMENT PROJECTS $4,630
11.407 INTERJURISDICTIONAL FISHERIES ACT OF 1986 $4,260
11.016 STATISTICAL, RESEARCH, AND METHODOLOGY ASSISTANCE $3,469
15.657 ENDANGERED SPECIES RECOVERY IMPLEMENTATION $2,790
15.631 PARTNERS FOR FISH AND WILDLIFE $2,755
17.600 MINE HEALTH AND SAFETY GRANTS $2,465
66.442 WATER INFRASTRUCTURE IMPROVEMENTS FOR THE NATION SMALL AND UNDERSERVED COMMUNITIES EMERGING CONTAMINANTS GRANT PROGRAM $852
20.514 PUBLIC TRANSPORTATION RESEARCH, TECHNICAL ASSISTANCE, AND TRAINING $794
93.041 SPECIAL PROGRAMS FOR THE AGING, TITLE VII, CHAPTER 3, PROGRAMS FOR PREVENTION OF ELDER ABUSE, NEGLECT, AND EXPLOITATION $70