FAC Explorer

Finding 367390 (2022-008)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2022
Accepted
2024-02-14
Audit: 290407
Organization: Northampton County (NC)
Auditor: Thompson Price Scott Adams & CO P A

AI Summary

  • Core Issue: Inadequate information was requested during eligibility determinations for Medicaid, leading to potential documentation gaps.
  • Impacted Requirements: Compliance with 42 CFR 435 was not met, as proper documentation and electronic matches were lacking.
  • Recommended Follow-up: Conduct internal reviews of case files to ensure all necessary information is documented and procedures for eligibility determinations are followed.

Finding Text

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medicaid Assistance Program (Medicaid; Title XIX) CFDA# 93.778 Finding 2022-008 Inadequate Request for Information SIGNIFICANT DEFICIENCY Eligibility NORTHAMPTON COUNTY, NORTH CAROLINA Schedule of Findings and Questioned Costs For the Year Ended June 30, 2022 Section III. Federal Award Findings (continued) 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. Electronic matches are required at applications and redeterminations. Condition: There were 17 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 cases from of a total of 255,485 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. 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 information is in place and necessary procedures are taken when determine eligibility. 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. See Corrective Action Plan. 136

Corrective Action Plan

Finding 2022-008 Inadequate Request for Information Name of contact: Corrective Action: Proposed Completion Date: Finding 2022-009 Inaccurate Resources Entry Name of contact: Lisa Broady, Adult Medicaid Supervisor Corrective Action: Proposed Completion Date: Meetings were held with staff on documenting the information received, requesting required information to determine eligibility, properly requesting online data and WorkNumber in NCFAST and entering the correct supporting information. The week of March 20, 2023 with implementation effective immediately. Meetings were held with staff to ensure that they are counting and imputing all information that are verified through AVS on all applications/recerts. Supervisor will continue to review 10 cases each month to assure correct information has been keyed. The week of March 20, 2023 with implementation effective immediately. Corrective Action Plan For the Year Ended June 30, 2022 Section III - Federal Award Findings and Question Costs (continued) Meetings were held with staff to ensure that OVS, AVS, WorkNumber and property checks are being run in NCFAST and that all supporting information has been entered correctly into NCFAST. Also, training included proper use of the 1/3 reduction budgeting procedures. The week of March 20, 2023 with implementation effective immediately. Lisa Broady, Adult Medicaid Supervisor and Felicia Bullock, Family and Children's Medicaid Supervisor Lisa Broady, Adult Medicaid Supervisor and Felicia Bullock, Family and Children's Medicaid Supervisor

Categories

Eligibility Significant Deficiency

Other Findings in this Audit

  • 367388 2022-006
    Significant Deficiency Repeat
  • 367389 2022-007
    Significant Deficiency Repeat
  • 367391 2022-009
    Significant Deficiency
  • 367392 2022-010
    Significant Deficiency
  • 367393 2022-011
    Significant Deficiency
  • 943830 2022-006
    Significant Deficiency Repeat
  • 943831 2022-007
    Significant Deficiency Repeat
  • 943832 2022-008
    Significant Deficiency Repeat
  • 943833 2022-009
    Significant Deficiency
  • 943834 2022-010
    Significant Deficiency
  • 943835 2022-011
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $1.28M
21.027 Coronavirus State and Local Fiscal Recovery Funds $953,569
93.568 Low-Income Home Energy Assistance $796,438
93.563 Child Support Enforcement $548,126
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $488,625
93.558 Temporary Assistance for Needy Families $389,197
93.667 Social Services Block Grant $199,331
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $115,851
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $69,525
93.658 Foster Care_title IV-E $62,462
93.994 Maternal and Child Health Services Block Grant to the States $55,851
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $50,471
93.268 Immunization Cooperative Agreements $48,671
93.940 Hiv Prevention Activities_health Department Based $48,621
97.042 Emergency Management Performance Grants $39,286
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $38,965
93.217 Family Planning_services $32,910
93.069 Public Health Emergency Preparedness $31,664
93.991 Preventive Health and Health Services Block Grant $30,607
16.738 Edward Byrne Memorial Justice Assistance Grant Program $21,190
93.767 Children's Health Insurance Program $19,766
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $8,721
93.053 Nutrition Services Incentive Program $2,842
93.659 Adoption Assistance $872
93.556 Promoting Safe and Stable Families $797
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $238
93.645 Stephanie Tubbs Jones Child Welfare Services Program $79
93.977 Preventive Health Services_sexually Transmitted Diseases Control Grants $57
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $50
93.560 Family Support Payments to States_assistance Payments $-364