Finding 20133 (2022-004)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2022

Accepted

2023-02-19

Audit: 22511

Organization: Edgecombe County (NC)

Auditor: Thompson Price Scott Adams & CO P A

AI Summary

Core Issue: Inaccurate information entry led to potential eligibility errors in Medicaid determinations.
Impacted Requirements: Compliance with 42 CFR 435 and 2 CFR 200 regarding documentation and internal controls for eligibility.
Recommended Follow-Up: Conduct internal reviews and retrain staff on proper documentation practices to ensure accurate eligibility determinations.

Finding Text

US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2022-004 Inaccurate Information Entry SIGNIFICANT DEFICIENCY ELIGIBILITY Criteria: 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. Condition: There were 25 errors discovered during our procedures that inaccurate information was entered when determining eligibility. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 957,769 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. Effect: 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-009. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details.

Corrective Action Plan

Finding: 2022-004 Inaccurate Information Entry Name of contact person: Veronica Lyons, Tina Radford, Virginia Ewuell, & Angel Joyner/Medicaid Supervisors Corrective Action: Files will be reviewed internally by Medicaid Supervisors and Quality Control workers to ensure proper documentation is in place for eligibility. Workers will be retrained on what files should contain and the importance of complete and accurate record keeping. The workers have also been provided an agency/State approved checklist that includes everything that should be included in a case. All files will include online verifications, documented resources of income and those amounts will match information in NCFAST. The workers have been provided a State approved automated budget that will be completed and compared to the information in NCFAST. The results found or documentation made in case notes will clearly indicate what actions were performed and the results of those actions. Workers have been provided an agency/State approved documentation template to use for each case. "Proposed Completion Date: Training and corrections will be completed by January 15, 2023. Case record reviews are currently being conducted and will be ongoing."

Other Findings in this Audit

20129 2022-009

Significant Deficiency
20130 2022-010

Significant Deficiency
20131 2022-008

Significant Deficiency
20132 2022-003

Significant Deficiency Repeat
20134 2022-005

Significant Deficiency Repeat
20135 2022-006

Significant Deficiency Repeat
20136 2022-007

Significant Deficiency Repeat
596571 2022-009

Significant Deficiency
596572 2022-010

Significant Deficiency
596573 2022-008

Significant Deficiency
596574 2022-003

Significant Deficiency Repeat
596575 2022-004

Significant Deficiency Repeat
596576 2022-005

Significant Deficiency Repeat
596577 2022-006

Significant Deficiency Repeat
596578 2022-007

Significant Deficiency Repeat

Programs in Audit

ALN	Program Name	Expenditures
21.027	Coronavirus State and Local Fiscal Recovery Funds	$3.07M
93.778	Medical Assistance Program	$2.08M
93.563	Child Support Enforcement	$1.02M
93.658	Foster Care_title IV-E	$368,086
10.557	Special Supplemental Nutrition Program for Women, Infants, and Children	$327,658
93.994	Maternal and Child Health Services Block Grant to the States	$191,759
93.044	Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers	$157,596
93.568	Low-Income Home Energy Assistance	$155,681
93.596	Child Care Mandatory and Matching Funds of the Child Care and Development Fund	$125,663
93.323	Epidemiology and Laboratory Capacity for Infectious Diseases (elc)	$125,431
21.019	Coronavirus Relief Fund	$110,338
93.000	Foster Care	$107,485
93.045	Special Programs for the Aging_title Iii, Part C_nutrition Services	$61,173
93.217	Family Planning_services	$53,723
10.760	Water and Waste Disposal Systems for Rural Communities	$48,196
16.001	Law Enforcement Assistance_narcotics and Dangerous Drugs_laboratory Analysis	$40,140
93.991	Preventive Health and Health Services Block Grant	$35,560
10.561	State Administrative Matching Grants for the Supplemental Nutrition Assistance Program	$32,003
93.069	Public Health Emergency Preparedness	$28,998
93.053	Nutrition Services Incentive Program	$22,933
93.767	Children's Health Insurance Program	$22,313
93.558	Temporary Assistance for Needy Families	$21,187
93.116	Project Grants and Cooperative Agreements for Tuberculosis Control Programs	$19,187
93.645	Stephanie Tubbs Jones Child Welfare Services Program	$16,124
93.556	Promoting Safe and Stable Families	$14,931
20.600	State and Community Highway Safety	$14,922
97.042	Emergency Management Performance Grants	$12,696
93.674	John H. Chafee Foster Care Program for Successful Transition to Adulthood	$10,685
93.268	Immunization Cooperative Agreements	$10,585
93.667	Social Services Block Grant	$9,786
93.659	Adoption Assistance	$8,806
93.391	Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises	$6,993
93.898	Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations	$1,625
93.297	Teenage Pregnancy Prevention Program	$1,384
97.067	Homeland Security Grant Program	$574
93.000	IV-E Adoption	$234
97.039	Hazard Mitigation Grant	$142
93.566	Refugee and Entrant Assistance_state Administered Programs	$-839