Finding 382452 — 2023-050

Program: AL 93.778 – Medical Assistance Program; AL 93.778 – COVID-19 Medical Assistance Program - Allowability Grant Number & Year: 2305NE5MAP, FFY 2023; 2205NE5MAP, FFY 2022 Federal Grantor Agency: U.S. Department of Health and Human Services Criteria: Per 45 CFR § 75.302(a) (October 1, 2022), “Each state must expend and account for the Federal award in accordance with state laws and procedures for expending and accounting for the state's own funds.” Per 45 CFR § 75.403 (October 1, 2022), costs must be necessary, reasonable, and adequately documented. Title 471 NAC 15-003.02(H) requires that the provider perform the personal assistance services noted on the service plan, accurately documenting services provided in the Electronic Visit Verification (EVV) system and confirming that services were received as authorized according to Agency procedures. Title 471 NAC 15-005.02(A) states, “Providers cannot provide services to more than one client at a time.” That same regulation says also, “Medicaid will not pay for services that were not performed during the actual hours noted by the provider in the Electronic Visit Verification (EVV) system.” A good internal control plan requires procedures to ensure that services provided agree to the service needs assessment. Section 1903(l)(5)(A) of the Social Security Act states the following: The term “electronic visit verification system” means, with respect to personal care services or home health care services, a system under which visits conducted as part of such services are electronically verified with respect to – (i) the type of service performed; (ii) the individual receiving the service; (iii) the date of the service; (iv) the location of service delivery; (v) the individual providing the service; and (vi) the time the service begins and ends. Public Law 114-255, § 12006 (December 13, 2016) (“21st Century Cures Act”) provides, as is relevant, the following: (a) Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended by inserting after subsection (k) the following new subsection: ‘‘(l)(1) Subject to paragraphs (3) and (4), with respect to any amount expended for personal care services or home health care services requiring an in-home visit by a provider that are provided under a State plan under this title (or under a waiver of the plan) and furnished in a calendar quarter beginning on or after January 1, 2019 (or, in the case of home health care services, on or after January 1, 2023), unless a State requires the use of an electronic visit verification system for such services furnished in such quarter under the plan or such waiver, the Federal medical assistance percentage shall be reduced— ‘‘(A) in the case of personal care services— ‘‘(i) for calendar quarters in 2019 and 2020, by .25 percentage points; ‘‘(ii) for calendar quarters in 2021, by .5 percentage points; ‘‘(iii) for calendar quarters in 2022, by .75 percentage points; and ‘‘(iv) for calendar quarters in 2023 and each year thereafter, by 1 percentage point[.] 42 CFR § 440.167(a)(2) (October 1, 2022) states, in part, that personal care services are those provided “by an individual who is qualified to provide such services and who is not a member of the individual's family[.]” 42 CFR § 440.167(b) adds, “For purposes of this section, family member means a legally responsible relative.” Neb. Rev. Stat. § 28-512 (Reissue 2016) creates the offense of “theft by deception.” That statute says the following, in relevant part: A person commits theft if he obtains property of another by deception. A person deceives if he intentionally: (1) Creates or reinforces a false impression, including false impressions as to law, value, intention, or other state of mind; but deception as to a person's intention to perform a promise shall not be inferred from the fact alone that he did not subsequently perform the promise; or (2) Prevents another from acquiring information which would affect his judgment of a transaction; or (3) Fails to correct a false impression which the deceiver previously created or reinforced, or which the deceiver knows to be influencing another to whom he stands in a fiduciary or confidential relationship[.] Further, Neb. Rev. Stat. § 28-911 (Reissue 2016) prohibits “abuse of public records,” as follows: (1) A person commits abuse of public records, if: (a) He knowingly makes a false entry in or falsely alters any public record; or (b) Knowing he lacks the authority to do so, he intentionally destroys, mutilates, conceals, removes, or impairs the availability of any public record; or (c) Knowing he lacks the authority to retain the record, he refuses to deliver up a public record in his possession upon proper request of any person lawfully entitled to receive such record; or (d) He makes, presents, or uses any record, document, or thing, knowing it to be false, and with the intention that it be taken as a genuine part of the public record. (2) As used in this section, the term public record includes all official books, papers, or records created, received, or used by or in any governmental office or agency. (3) Abuse of public records is a Class II misdemeanor. Condition: During testing of personal assistance service (PAS) claims, we noted the following: • Personal assistance services appeared to be claimed at the same time that the provider was working at another job or at other activities, resulting in apparent fraudulent billings and payments. • Services provided lacked adequate supporting documentation. This included providers being able to submit claims without verifying the location where those services were provided. • Services billed exceeded the number of hours authorized under the service needs assessments. • Providers billed for unreasonable amounts of time – including, among other things, for more daily hours than are in a 24-hour period and for unfeasible scenarios, such as the supposed performance of a week’s worth of duties for one client in only three days. • Providers received overtime pay for unauthorized services, meaning that they were compensated at an increased rate for services ineligible for payment in the first place. • Client guardians or parents were paid for providing services, which violates governing regulations prohibiting such arrangements. A similar finding has been noted in prior audits since 2014. Repeat Finding: 2022-039 Questioned Costs: $53,758 known See Schedule of Findings and Questioned Costs for chart/table. Statistical Sample: No Context: The Agency offers PAS (assistance with hygiene, mobility, housekeeping, etc.) to Medicaid recipients with disabilities and chronic conditions. The services to be provided are based on individual needs and criteria that must be determined in a written service needs assessment (SNA). The Agency implemented an EVV system for PAS providers on January 3, 2021, as required by Section 12006(a) of the 21st Century Cures Act, passed by Congress in 2016. The EVV system electronically captures and verifies provider visit information, and providers were required to submit claims to the Agency electronically through this application. We initially selected five provider payments for testing – and, from those, one week of services submitted through the EVV system. A week of service billed by the provider may include multiple claims and clients. Due to the numerous issues identified with the billings, we expanded testing and randomly selected an additional five provider payments for testing, and one week of services. We noted issues with 9 of 10 providers tested. In addition to the billing issues identified for the weeks tested, we also noted that three of these providers had outside employment or participated in activities that conflicted with the PAS hours billed. We obtained more documentation for additional weeks. Based on the documentation obtained, we identified $14,397 in potentially fraudulent payments made to the providers during fiscal year 2023. See Schedule of Findings and Questioned Costs for chart/table. In addition to the potentially fraudulent payments related to hours claimed while at another job or activity, we noted $44,534 in Federal payment errors related to other issues, for total Federal questioned costs of $53,758. The Federal share of payments tested totaled $81,926. The total Federal share of PAS claims for the fiscal year was $5,416,039, and the State share was $3,814,632. Federal payment errors noted in the random sample totaled $268. The total Federal sample tested for the random sample was $979. The total dollar error rate was 27.37%, which estimates the potential dollars at risk for fiscal year 2023 to be $1,482,370 (dollar rate multiplied by the population). The following details issues with each provider. Provider #1 This provider was authorized a total of 87.25 hours of service per week for three different clients. For the week tested, the provider manually created the claims for payment and did not use the EVV system to create a visit form; therefore, the claims did not capture client signatures or verify the location of the visit through the Global Positioning System (GPS). Likewise, there was no listing of the activities performed to ensure compliance with the SNA. We requested the claim detail for a second week of services and, again, the provider manually created the claims and did not enter a visit in the EVV system. Consequently, we questioned all of the claims selected for testing. We noted further that the provider exceeded the SNA by 12 hours and billed 24.5 hours of service on one day, which is impossible. We reviewed three additional weeks of claims and noted also that the provider exceeded the SNA by .25 to 2 hours each week, resulting in additional questioned costs. Most concerning was the fact that the provider worked two additional jobs during the time that she billed for personal assistance services. The provider worked as a dental hygienist and as a pharmacy technician. The provider billed personal assistance services beginning at 6:00 a.m. every day until at least 5:30 p.m. The dental office with which the provider was employed was open only from 8:00 a.m. to 5:00 p.m., Monday through Friday. During the week of February 5, 2023, the provider claimed 87 hours for PAS, of which 43.75 hours were claimed to have been provided between 8:00 a.m. and 5:00 p.m., Monday through Friday. As the provider did not use the EVV, it is unknown where she was at the times the services were claimed; however, considering the provider’s other employment, it is possible that fraud may have occurred. We obtained the pharmacy technician employment records for the provider and compared the PAS billings to those records from July 2022 through January 2023. We identified 101 days during which PAS hours billed overlapped with times that the provider was working as a pharmacy technician. In determining these overlapped hours, we did not factor in any travel time that may have occurred between client homes and the provider’s place of employment; therefore, the possibility of additional fraudulent payments exists. The provider billed 1,200 hours of personal assistance services during this time period, and more than half of these hours could not have been provided. We questioned 770 hours as potential fraud, totaling $8,678. We also noted that the provider did not complete all of the PAS visits through a device using GPS; therefore, additional questioned costs resulted from not using the GPS verification method. Given that many of the visits completed with GPS verification overlapped with the times that the provider was working at the pharmacy, another individual appears to have aided the provider in falsely claiming that personal assistance services were provided. The employment records for the provider included the exact time punched in and out for the shifts worked. Below are a few examples of the hours billed by the provider and the hours the provider worked at the pharmacy. Clients 1 and 2 live at the same residence, and Client 3 is the provider’s mother. See Schedule of Findings and Questioned Costs for chart/table. In addition to the apparent fraudulent hours billed, the provider received overtime pay for the weeks reviewed. Providers are paid at time and one-half for services in excess of 40 hours each week. The provider evidently received overtime pay, in part, due to the apparent fraudulent billing. The provider was paid overtime for 21 weeks from July 2022 through December 2022. This resulted in additional questioned costs of $3,140 for potential fraud. Federal questioned costs not related to other employment totaled $3,604. Provider #2 This provider was authorized a total of 116.75 hours of service per week for four different clients. For the week tested of December 18, 2022, through December 24, 2022, the provider billed 121.25 hours of service. This provider manually completed visits; consequently, there was no location verification, and no client signatures were captured. Therefore, we questioned the claims for the week tested. We also identified other issues for the week tested. We noted the provider billed a total of 32 hours of service for the four clients on December 22, 2022, which is impossible. Also, for one client, the visit forms for this day supported only 2.75 hours, but the provider billed 20 hours for the client. The provider also exceeded the service authorization by 75 quarterly units or 18.75 hours for the week. Due to the issues noted, we reviewed additional weeks and claims of service. This resulted in more questioned costs for the provider exceeding the SNA. The provider exceeded the SNA for 8 of the 15 weeks reviewed, ranging from .25 to 11.5 hours overbilled. Per documentation in the case file, the provider was involved in a court case pertaining to her own child. On December 2, 2022, a law enforcement raid was conducted at the provider’s home, which revealed Fentanyl and firearms. The provider was not present at the time and, when contacted later, claimed to be on vacation; however, the provider billed for 14.5 hours of services that day. Despite appearing in court on December 20, 2022, at 11:30 a.m., the provider billed for client services that same day from 10:15 a.m. to 1:30 p.m. Based on these discrepancies, we requested the EVV records for the remaining days billed in December 2022. None of the additional visit forms were completed through a device using GPS to track the location, and no signatures were obtained; therefore, we questioned these claims. The case file also included documentation of supervised visits that occurred between the provider and the provider’s child at the provider’s home. Reviewing the EVV records for the days that the visits occurred, we noted that the times the provider billed for PAS services overlapped with the times of these supervised visits. The provider could not have provided the majority of PAS services billed on these days. Again, the visit forms did not contain verification of the location where the services were provided. We questioned the hours billed for each of these days. See Schedule of Findings and Questioned Costs for chart/table. Lastly, the provider had other employment as a medical assistant and a student bus driver. It is likely that the hours of other employment conflicted with the PAS hours billed. We requested the provider’s employment records for July 2022 through December 2022. While comparing the employment records to the days and hours billed for PAS services, we identified 40 days from June 27, 2022, through November 16, 2022, during which hours worked overlapped with times billed for PAS services. We questioned any PAS hours billed that overlapped with the provider’s employment hours as potential fraud. In determining these overlapped hours, we did not factor in any travel time that may have occurred between client homes and the provider’s place of employment; therefore, the possibility of additional fraudulent payments exists. We also noted the provider did not complete the PAS visits through a device using GPS; therefore, any times billed on these 40 days were also questioned for inadequate documentation. Apparent fraudulent PAS hours billed totaled $1,383. Overlapping times ranged from 1.25 hours to 5.25 hours per day. The table below contains a few examples of overlapping hours billed by the provider: See Schedule of Findings and Questioned Costs for chart/table. In addition to the apparent fraudulent overlapped hours, the provider was paid for overtime for the weeks reviewed. The provider received overtime, in part, due to the apparent fraudulent billing. All overtime hours paid during fiscal year 2023 were questioned, either due to the fraudulent hours billed for the week, or for inadequate documentation for not using the GPS verification method. This resulted in additional questioned costs of $204 for potential fraud. Federal questioned costs not related to employment issues totaled $6,671. Provider #3 This provider was authorized a total of 97.5 hours of service per week for four clients. For the week initially tested, six visit forms were entered through a personal computer, so there was no location verification and no client signature. Five of these visits occurred in the evening, from 7:00 p.m. to 10:15 p.m., for 3.25 hours. The provider incorrectly billed 4 hours for one of these visits. The visits with no location verification were questioned. We also noted mileage variances on the visit forms entered through a mobile device when GPS tracking was utilized. There were two visits with a 20-mile variance from the location of the client and where the provider apparently ended the visit. There are unknown questioned costs for these mileage variances. The service authorizations for each of the clients included some services to be performed every day of the week; however, only two of the four clients were billed daily for services. For example, if a client was authorized for a bath seven times per week, but the provider performed the service on only three days, we considered the hours charged for four baths to be overbilled. We reviewed additional weeks during the fiscal year, and there were additional questioned costs based on the frequency of the task authorized. This provider also received overtime pay for several of the weeks reviewed. Therefore, the provider was not only overpaid due to billing for tasks that were not provided as authorized but also received overtime pay based upon some of those overbillings, resulting in additional questioned costs. Federal questioned costs for issues not related to other employment and activities totaled $880. The provider was also receiving wages from a home health care company during fiscal year 2023. Based on the wages earned there, the provider appears to have been working full-time, and hours claimed for PAS likely overlapped with hours worked at the home health care company. We requested the provider’s employment records from the home health care company, and the employer responded that the provider was a salaried employee and did not have a set schedule. The provider also stated that a timesheet was not kept. We performed a social media search and found several posts on Facebook that depicted the provider being out of-state on several weekends during fiscal year 2023. We compared those apparent out-of-state dates to the dates of billed services. The provider billed at least nine days that conflicted with these trips outside of Nebraska. The provider billed 94.25 hours during these days, resulting in potential fraud of $992. Four of the nine days billed did not use the GPS verification method for any of the clients. Based on the Facebook posts, however, the provider was attending an event in Indianapolis, Indiana, on March 11 and 12, 2023, but billed 8.25 hours of services for each of these days. On March 31, 2023, the provider billed 15.75 hours; however, she appeared to be in Arizona. No GPS verification was used on June 6, 2023, and the provider billed 10.75 hours, but appeared to be in Arizona. For the remaining five days, the hours billed did not agree to the times logged through GPS. Additionally, times overlapped between services, and travel time between client homes was unreasonable, or part of the hours billed did not use the GPS verification method. For those visit forms that indicated GPS verification was used, another individual may have entered information into the verification system. The table below contains examples of some of the discrepancies noted: See Schedule of Findings and Questioned Costs for chart/table. Provider #4 The Agency authorized this provider to provide 118 hours of service per week (approximately 40 hours for each of 3 clients). It is not reasonable to authorize this many hours of service for one provider, as it would take over 17 hours every day of the week in order to perform all the tasks noted on the SNA. For the week tested, the provider billed 454 quarterly units or 113.5 hours. This included billing 9.5 hours on November 18, 2022, from 7:10 p.m. to 12:04 a.m., even though this is only 5 hours, and then an additional 23.75 hours on November 19, 2022, from 12:06 a.m. to 11:57 p.m. Each SNA of these clients included some services to be performed every day of the week. The provider billed for tasks authorized for seven days per week but did not provide services on each of those seven days for all clients. For example, if a client was authorized for a bath seven times for the week, but the provider performed services on only three days, we considered the hours charged for four baths to be overbilled. We reviewed an additional two weeks of services and found more errors for not following the SNA. There were $757 Federal questioned costs for not following the SNA. It should be noted that only these three weeks were reviewed, so there may be additional questioned costs for other weeks based on the frequency of the task authorized. See Schedule of Findings and Questioned Costs for chart/table. The provider also received overtime pay for these three weeks. In addition to being overpaid due to billing for tasks that were not provided as authorized, the provider received overtime pay for this overbilling, resulting in an additional $269 in Federal questioned costs. Providers are paid at time and one-half for services in excess of 40 hours each week. Per the Agency, a claims overtime team reviews the service authorizations to ensure they are not exceeded. For the three weeks reviewed alone, the provider was paid for 60.82, 73.86 and 61.65 hours of overtime. This provider has had similar findings in prior audits since 2021, with no changes to the number of hours authorized by the Agency. Provider #5 Per documentation provided from the EVV system for the week tested, the provider used a personal computer to clock in and out, so there was no GPS verification of the visit location. The visit forms noted that the provider was unable to clock in with a cell phone; however, the services were being provided at the provider’s home. On April 14, 2023, the Agency notified the provider by letter that using a personal computer that did not have GPS to verify location was not compliant with either the Cures Act or Agency EVV guidelines. This letter gave the provider 90 days to achieve compliance. The Agency sent a second noncompliance letter to the provider on August 30, 2023, giving her an additional 30 days to comply. The claims tested are questioned due to the provider’s failure to comply with Federal regulations. We noted also that the provider was the parent and co-guardian of the two clients to whom services were provided. Per 42 CFR § 440.167, personal care services cannot be provided by a member of the individual’s family. A family member is defined as “a legally responsible relative.” As the co-guardian, the provider was a legally responsible relative of the clients and, therefore, not allowed to be paid for those services. Thus, all payments made during fiscal year 2023 are questioned. The Federal share was $32,083. Provider #6 The provider used a device with GPS tracking to record her visits. Although the visit form supported only 3.75 hours of services, the provider billed 5 hours, resulting in Federal questioned costs of $9. Provider #7 This provider was authorized for up to 107 quarterly hour units or up to 26.75 hours of PAS services per week. For the week tested, the provider used a personal computer to complete visits in the EVV system, resulting in the location not being verified through GPS tracking and no client signatures being obtained. Therefore, we question the claims, resulting in Federal questioned costs of $202. We also noted that the provider performed personal care services for two additional clients under the Aged and Disabled Waiver. One of these clients also lived with the client to whom PAS services were provided. Because the provider did not use a device with GPS tracking, it is possible that she could have provided services for these two clients during the same time, which is not allowable. For the week tested, the provider billed a total of 116 hours of service for all three clients. The provider also exceeded the authorization for the week tested by 1.25 hours. We noted that the Agency sent a letter to the provider in April 2023 about the overbilling of 1.25 hours for the week tested; however, the accounts receivable was not established until September 30, 2023, after we inquired about the overbilling. The Agency also sent a letter to the provider on April 14, 2023, giving her 90 days to comply with the EVV regulations. No changes were made, so the Agency sent a second letter to the provider on August 30, 2023, giving the provider an additional 30 days to come into compliance. A third letter was sent on September 29, 2023, giving the provider an additional 30 days to comply. It is unreasonable to allow a provider who is not compliant with EVV regulations to continue billing for five months of services. The provider was also paid for overtime hours for the week tested. The provider received $351 in Federal share overtime pay for 74.75 hours of overtime. The overtime was paid under the PAS program. However, only 26.75 hours were related to PAS, and 88 hours were billed under the Aged and Disabled (AD) Waiver; therefore, the overtime should have been charge under the AD Waiver. Per the Agency, the overtime was paid under the PAS program because the Federal share reimbursement is higher, which is not reasonable. Provider #8 This provider was authorized for up to 164 quarterly hour units or up to 41 hours per week for two clients living in the same household. The provider exceeded the service authorization for both clients by .25 hours each, resulting in Federal questioned costs of $4. The service authorization for both clients included some services to be performed every day of the week; however, services performed were not reasonable based on the times the provider billed. For example, one client was authorized for reminding or coaxing to eat three times a day for seven days a week. The provider billed from 6:00 a.m. to 9:30 a.m. every day for this client. It is not reasonable that the client would be eating only in the morning. We allowed the hours charged for one meal. Additionally, both clients were authorized for the administration of medication three times a day for seven days; however, based on the time during which the provider was providing services, the administration of medication appears to have occurred only once per day. This resulted in additional Federal questioned costs of $51. Provider #9 The provider used a device with GPS tracking to record her visits; however, the provider exceeded the SNA by two quarterly units or .5 hours for one client resulting in Federal questioned costs of $4. Cause: Procedures were inadequate to prevent and/or detect errors. Effect: An inadequate review of PAS claims increases the risk of services provided not being in accordance with the recipient’s needs, as well as a risk of services being billed but not provided. There is a significant risk for fraud or abuse to occur and not be detected. State and Federal funds appear to have been misspent. Recommendation: We recommend the Agency implement procedures to ensure payments are allowable, adequately supported, and in accordance with State and Federal regulations. We further recommend the Agency immediately discontinue paying claims that are not in accordance with EVV/GPS requirements. Additionally, because this comment gives rise to concerns regarding possible violations of State statute, we are forwarding the information herein to the Nebraska Attorney General for further review. Management Response: The Agency agrees.

ALN	Program Name	Expenditures
10.551	Supplemental Nutrition Assistance Program	$314.95M
21.027	Coronavirus State and Local Fiscal Recovery Funds	$201.77M
93.778	Medical Assistance Program	$169.04M
93.575	Child Care and Development Block Grant	$127.03M
10.542	Pandemic Ebt Food Benefits	$76.56M
84.010	Title I Grants to Local Educational Agencies	$59.35M
93.558	Temporary Assistance for Needy Families	$38.60M
12.401	National Guard Military Operations and Maintenance (o&m) Projects	$34.94M
10.557	Special Supplemental Nutrition Program for Women, Infants, and Children	$31.76M
20.205	Highway Planning and Construction	$28.64M
21.026	Homeowner Assistance Fund	$28.57M
10.553	School Breakfast Program	$26.44M
93.563	Child Support Enforcement	$24.95M
93.323	Epidemiology and Laboratory Capacity for Infectious Diseases (elc)	$22.44M
64.015	Veterans State Nursing Home Care	$21.96M
93.596	Child Care Mandatory and Matching Funds of the Child Care and Development Fund	$21.18M
97.036	Disaster Grants - Public Assistance (presidentially Declared Disasters)	$19.60M
10.555	National School Lunch Program	$18.83M
93.566	Refugee and Entrant Assistance_state Administered Programs	$18.65M
20.933	National Infrastructure Investments	$18.34M
12.400	Military Construction, National Guard	$17.92M
66.468	Capitalization Grants for Drinking Water State Revolving Funds	$15.66M
66.458	Capitalization Grants for Clean Water State Revolving Funds	$15.52M
93.268	Immunization Cooperative Agreements	$14.19M
84.126	Rehabilitation Services_vocational Rehabilitation Grants to States	$14.18M
93.391	Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises	$14.11M
93.434	Every Student Succeeds Act/preschool Development Grants	$13.11M
16.575	Crime Victim Assistance	$12.89M
15.611	Wildlife Restoration and Basic Hunter Education	$11.39M
93.667	Social Services Block Grant	$11.20M
96.001	Social Security_disability Insurance	$10.50M
84.011	Migrant Education_state Grant Program	$9.65M
84.367	Improving Teacher Quality State Grants	$9.17M
21.023	Emergency Rental Assistance Program	$8.19M
84.027	Special Education_grants to States	$8.13M
84.048	Career and Technical Education -- Basic Grants to States	$7.76M
14.228	Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii	$7.53M
20.106	Airport Improvement Program	$7.33M
84.369	Grants for State Assessments and Related Activities	$6.81M
93.917	Hiv Care Formula Grants	$6.47M
84.287	Twenty-First Century Community Learning Centers	$6.21M
93.155	Rural Health Research Centers	$5.30M
93.767	Children's Health Insurance Program	$5.07M
93.069	Public Health Emergency Preparedness	$5.05M
17.207	Employment Service/wagner-Peyser Funded Activities	$5.05M
10.569	Emergency Food Assistance Program (food Commodities)	$4.84M
93.243	Substance Abuse and Mental Health Services_projects of Regional and National Significance	$4.22M
93.136	Injury Prevention and Control Research and State and Community Based Programs	$4.08M
84.365	English Language Acquisition State Grants	$3.92M
17.259	Wia Youth Activities	$3.84M
20.600	State and Community Highway Safety	$3.80M
93.994	Maternal and Child Health Services Block Grant to the States	$3.68M
84.002	Adult Education - Basic Grants to States	$3.68M
20.218	National Motor Carrier Safety	$3.67M
15.605	Sport Fish Restoration Program	$3.64M
97.067	Homeland Security Grant Program	$3.51M
15.018	Energy Community Revitalization Program	$3.29M
17.278	Wia Dislocated Worker Formula Grants	$3.16M
16.554	National Criminal History Improvement Program (nchip)	$2.89M
14.239	Home Investment Partnerships Program	$2.87M
81.042	Weatherization Assistance for Low-Income Persons	$2.86M
93.568	Low-Income Home Energy Assistance	$2.86M
93.991	Preventive Health and Health Services Block Grant	$2.84M
14.275	Housing Trust Fund	$2.81M
93.788	Opioid Str	$2.72M
17.258	Wia Adult Program	$2.61M
20.616	National Priority Safety Programs	$2.61M
10.565	Commodity Supplemental Food Program	$2.56M
66.460	Nonpoint Source Implementation Grants	$2.50M
93.959	Block Grants for Prevention and Treatment of Substance Abuse	$2.45M
14.231	Emergency Solutions Grant Program	$2.45M
10.559	Summer Food Service Program for Children	$2.31M
10.582	Fresh Fruit and Vegetable Program	$2.26M
93.898	Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations	$2.20M
21.U01	State Small Business Credit Initiative (ssbci)	$2.07M
93.659	Adoption Assistance	$2.04M
64.005	Grants to States for Construction of State Home Facilities	$1.88M
20.509	Formula Grants for Rural Areas and Tribal Transit Program	$1.77M
93.045	Special Programs for the Aging_title Iii, Part C_nutrition Services	$1.71M
84.368	Grants for Enhanced Assessment Instruments	$1.69M
93.645	Stephanie Tubbs Jones Child Welfare Services Program	$1.58M
93.889	National Bioterrorism Hospital Preparedness Program	$1.58M
93.354	Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response	$1.58M
64.014	Veterans State Domiciliary Care	$1.55M
94.006	Americorps	$1.54M
97.045	Cooperating Technical Partners	$1.48M
97.012	Boating Safety Financial Assistance	$1.32M
93.569	Community Services Block Grant	$1.31M
10.170	Specialty Crop Block Grant Program - Farm Bill	$1.30M
16.588	Violence Against Women Formula Grants	$1.27M
84.421	Disability Innovation Fund (dif)	$1.24M
95.001	High Intensity Drug Trafficking Areas Program	$1.19M
93.775	State Medicaid Fraud Control Units	$1.18M
10.561	State Administrative Matching Grants for the Supplemental Nutrition Assistance Program	$1.16M
15.634	State Wildlife Grants	$1.16M
10.093	Voluntary Public Access and Habitat Incentive Program	$1.13M
93.977	Preventive Health Services_sexually Transmitted Diseases Control Grants	$1.12M
16.813	Nics Act Record Improvement Program	$1.09M
84.372	Statewide Longitudinal Data Systems	$1.07M
93.053	Nutrition Services Incentive Program	$1.06M
10.025	Plant and Animal Disease, Pest Control, and Animal Care	$1.03M
45.025	Promotion of the Arts_partnership Agreements	$1.02M
93.674	John H. Chafee Foster Care Program for Successful Transition to Adulthood	$1.01M
10.560	State Administrative Expenses for Child Nutrition	$936,822
17.801	Jobs for Veterans State Grants	$920,120
93.426	Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke	$898,462
15.904	Historic Preservation Fund Grants-in-Aid	$896,233
93.940	Hiv Prevention Activities_health Department Based	$892,339
93.958	Block Grants for Community Mental Health Services	$832,562
66.432	State Public Water System Supervision	$822,136
93.241	State Rural Hospital Flexibility Program	$811,967
93.044	Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers	$805,513
20.513	Enhanced Mobility of Seniors and Individuals with Disabilities	$774,060
90.404	2018 Hava Election Security Grants	$753,903
93.603	Adoption Incentive Payments	$739,940
17.002	Labor Force Statistics	$718,545
10.649	Pandemic Ebt Administrative Costs	$714,545
66.805	Leaking Underground Storage Tank Trust Fund Corrective Action Program	$712,383
16.741	Dna Backlog Reduction Program	$702,748
97.008	Non-Profit Security Program	$696,925
93.387	National and State Tobacco Control Program (b)	$680,295
16.320	Services for Trafficking Victims	$672,444
20.505	Metropolitan Transportation Planning and State and Non-Metropolitan Planning and Research	$658,252
17.225	Unemployment Insurance	$650,057
93.669	Child Abuse and Neglect State Grants	$624,663
39.003	Donation of Federal Surplus Personal Property	$620,724
17.504	Consultation Agreements	$597,676
66.817	State and Tribal Response Program Grants	$593,639
84.184	Safe and Drug-Free Schools and Communities_national Programs	$591,411
84.177	Rehabilitation Services_independent Living Services for Older Individuals Who Are Blind	$563,428
84.013	Title I State Agency Program for Neglected and Delinquent Children and Youth	$560,547
96.006	Supplemental Security Income	$559,385
84.173	Special Education_preschool Grants	$550,432
81.041	State Energy Program	$540,173
84.187	Supported Employment Services for Individuals with the Most Significant Disabilities	$540,000
84.425	Education Stabilization Fund	$534,248
10.568	Emergency Food Assistance Program (administrative Costs)	$532,946
93.464	Acl Assistive Technology	$532,403
93.658	Foster Care_title IV-E	$530,452
30.001	Employment Discrimination_title Vii of the Civil Rights Act of 1964	$530,241
93.747	Elder Abuse Prevention Interventions Program	$524,606
17.235	Senior Community Service Employment Program	$517,158
17.245	Trade Adjustment Assistance	$513,112
93.436	Well-Integrated Screening and Evaluation for Women Across the Nation (wisewoman)	$513,038
20.219	Recreational Trails Program	$493,930
17.271	Work Opportunity Tax Credit Program (wotc)	$489,636
93.165	Grants to States for Loan Repayment	$487,572
15.916	Outdoor Recreation_acquisition, Development and Planning	$477,286
93.324	State Health Insurance Assistance Program	$473,291
66.040	State Clean Diesel Grant Program	$473,261
20.200	Highway Research and Development Program	$469,950
20.700	Pipeline Safety Program State Base Grant	$459,863
84.181	Special Education-Grants for Infants and Families	$448,944
97.042	Emergency Management Performance Grants	$436,437
16.742	Paul Coverdell Forensic Sciences Improvement Grant Program	$428,199
93.110	Maternal and Child Health Federal Consolidated Programs	$424,685
84.196	Education for Homeless Children and Youth	$413,270
66.419	Water Pollution Control State, Interstate, and Tribal Program Support	$405,179
16.543	Missing Children's Assistance	$402,993
93.197	Childhood Lead Poisoning Prevention Projects_state and Local Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children	$398,188
66.804	Underground Storage Tank (ust) Prevention, Detection, and Compliance Program	$396,702
16.034	Coronavirus Emergency Supplemental Funding Program	$394,732
93.671	Family Violence Prevention and Services/domestic Violence Shelter and Supportive Services	$382,548
94.003	State Commissions	$380,950
10.541	Child Nutrition-Technology Innovation Grant	$379,057
10.579	Child Nutrition Discretionary Grants Limited Availability	$377,253
97.047	Pre-Disaster Mitigation	$366,995
93.800	Organized Approaches to Increase Colorectal Cancer Screening	$358,427
93.150	Projects for Assistance in Transition From Homelessness (path)	$352,343
84.323	Special Education - State Personnel Development	$346,796
66.802	Superfund State, Political Subdivision, and Indian Tribe Site-Specific Cooperative Agreements	$323,244
93.092	Affordable Care Act (aca) Personal Responsibility Education Program	$322,737
16.017	Sexual Assault Services Formula Program	$310,011
93.116	Project Grants and Cooperative Agreements for Tuberculosis Control Programs	$283,800
66.034	Surveys, Studies, Research, Investigations, Demonstrations, and Special Purpose Activities Relating to the Clean Air Act	$266,067
14.401	Fair Housing Assistance Program_state and Local	$262,945
93.071	Medicare Enrollment Assistance Program	$258,728
93.913	Grants to States for Operation of Offices of Rural Health	$244,307
93.235	Affordable Care Act (aca) Abstinence Education Program	$241,290
15.608	Fish and Wildlife Management Assistance	$239,541
10.525	Farm and Ranch Stress Assistance Network Competitive Grants Program (b)	$236,064
93.262	Occupational Safety and Health Program	$232,310
15.524	Recreation Resources Management	$229,938
84.325	Special Education - Personnel Development to Improve Services and Results for Children with Disabilities	$220,519
59.061	State Trade and Export Promotion Pilot Grant Program	$219,409
16.582	Crime Victim Assistance/discretionary Grants	$211,996
16.750	Support for Adam Walsh Act Implementation Grant Program	$210,179
16.576	Crime Victim Compensation	$210,176
10.558	Child and Adult Care Food Program	$207,250
93.946	Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs	$202,492
10.576	Senior Farmers Market Nutrition Program	$197,177
66.442	Assistance for Small and Disadvantaged Communities Drinking Water Grant Program (sdwa 1459a) (a)	$194,450
10.U01	Nebraska Rural Rehabilitation Program	$192,077
20.703	Interagency Hazardous Materials Public Sector Training and Planning Grants	$190,259
93.817	Hospital Preparedness Program (hpp) Ebola Preparedness and Response Activities	$187,662
97.041	National Dam Safety Program	$185,066
64.U01	Cooperative Agreement for Veteran Training Program	$184,459
93.413	The State Flexibility to Stabilize the Market Grant Program	$182,331
93.981	Improving Student Health and Academic Achievement Through Nutrition, Physical Activity and the Management of Chronic Conditions in Schools	$180,743
66.605	Performance Partnership Grants	$177,935
97.039	Hazard Mitigation Grant	$173,743
16.827	Justice Reinvestment Initiative	$172,570
10.666	Schools and Roads - Grants to Counties	$171,657
93.052	National Family Caregiver Support, Title Iii, Part E	$164,700
66.032	State Indoor Radon Grants	$162,061
97.023	Community Assistance Program State Support Services Element (cap-Ssse)	$161,708
10.578	Wic Grants to States (wgs)	$159,288
93.251	Early Hearing Detection and Intervention	$159,115
93.599	Chafee Education and Training Vouchers Program (etv)	$157,351
93.870	Maternal, Infant and Early Childhood Home Visiting Grant	$151,828
93.435	Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes and Heart Disease and Stroke-	$151,460
10.435	State Mediation Grants	$151,395
17.273	Temporary Labor Certification for Foreign Workers	$144,492
93.547	Affordable Care Act Ð National Health Service Corps	$143,995
66.461	Regional Wetland Program Development Grants	$142,638
93.079	Cooperative Agreements to Promote Adolescent Health Through School-Based Hiv/std Prevention and School-Based Surveillance	$137,162
10.574	Team Nutrition Grants	$136,101
84.051	Career and Technical Education -- National Programs	$135,530
93.600	Head Start	$133,458
16.550	State Justice Statistics Program for Statistical Analysis Centers	$133,436
84.144	Migrant Education_coordination Program	$127,810
11.032	State Digital Equity Planning Grants	$124,158
93.556	Promoting Safe and Stable Families	$119,343
94.009	Training and Technical Assistance	$111,347
93.314	Early Hearing Detection and Intervention Information System (ehdi-Is) Surveillance Program	$110,581
45.310	Grants to States	$109,173
16.738	Edward Byrne Memorial Justice Assistance Grant Program	$104,835
12.112	Payments to States in Lieu of Real Estate Taxes	$103,517
93.127	Emergency Medical Services for Children	$103,418
93.643	Children's Justice Grants to States	$100,477
66.454	Water Quality Management Planning	$100,168
12.113	State Memorandum of Agreement Program for the Reimbursement of Technical Services	$97,113
93.597	Grants to States for Access and Visitation Programs	$96,484
20.611	Incentive Grant Program to Prohibit Racial Profiling	$91,677
84.161	Rehabilitation Services_client Assistance Program	$89,937
15.626	Enhanced Hunter Education and Safety Program	$89,003
93.586	State Court Improvement Program	$88,575
93.967	Cdc's Collaboration with Academia to Strengthen Public Health	$83,758
21.019	Coronavirus Relief Fund	$82,277
93.497	Family Violence Prevention and Services/ Sexual Assault/rape Crisis Services and Supports	$80,247
21.029	Coronavirus Capital Projects Fund Program	$79,841
16.839	Stop School Violence	$79,064
66.444	Lead Testing in School and Child Care Program Drinking Water (sdwa 1464(d)) (a)	$77,472
20.614	National Highway Traffic Safety Administration (nhtsa) Discretionary Safety Grants	$75,313
84.326	Special Education_technical Assistance and Dissemination to Improve Services and Results for Children with Disabilities	$72,814
93.665	Emergency Grants to Address Mental and Substance Use Disorders During Covid-19	$72,346
15.637	Migratory Bird Joint Ventures	$71,971
66.433	State Underground Water Source Protection	$71,952
93.734	Empowering Older Adults and Adults with Disabilities Through Chronic Disease Self-Management Education Programs Ð Financed by Prevention and Public Health Funds (pphf)	$70,609
45.312	National Leadership Grants	$67,739
93.270	Adult Viral Hepatitis Prevention and Control	$65,365
16.922	Equitable Sharing Program	$59,104
10.575	Farm to School Grant Program	$58,272
10.572	Wic Farmers' Market Nutrition Program (fmnp)	$56,197
93.070	Environmental Public Health and Emergency Response	$54,923
84.377	School Improvement Grants	$54,773
93.279	Drug Abuse and Addiction Research Programs	$52,280
17.005	Compensation and Working Conditions	$44,969
16.812	Second Chance Act Reentry Initiative	$44,709
15.615	Cooperative Endangered Species Conservation Fund	$43,226
93.042	Special Programs for the Aging_title Vii, Chapter 2_long Term Care Ombudsman Services for Older Individuals	$42,357
10.556	Special Milk Program for Children	$41,349
93.048	Special Programs for the Aging_title Iv_and Title Ii_discretionary Projects	$35,199
10.U02	Hazardous Waste Management	$32,274
32.U01	Fcc - Certification	$31,570
11.307	Economic Adjustment Assistance	$29,941
93.U01	Medicated Feed Inspection Contract	$29,617
93.041	Special Programs for the Aging_title Vii, Chapter 3_programs for Prevention of Elder Abuse, Neglect, and Exploitation	$28,459
20.232	Commercial Driver's License Program Improvement Grant	$27,896
10.603	Emerging Markets Program	$24,035
93.090	Guardianship Assistance	$22,563
10.931	Agricultural Conservation Easement Program	$22,236
93.630	Developmental Disabilities Basic Support and Advocacy Grants	$19,500
20.U01	Federal Lands Highway Program	$16,142
97.044	Assistance to Firefighters Grant	$16,091
16.540	Juvenile Justice and Delinquency Prevention_allocation to States	$15,954
14.241	Housing Opportunities for Persons with Aids	$15,905
10.072	Wetlands Reserve Program	$15,547
93.234	Traumatic Brain Injury State Demonstration Grant Program	$14,830
16.U01	Dea Grants	$13,157
10.932	Regional Conservation Partnership Program	$12,233
10.477	Meat, Poultry, and Egg Products Inspection	$12,000
93.236	Grants to States to Support Oral Health Workforce Activities	$11,753
97.043	State Fire Training Systems Grants	$11,142
20.215	Highway Training and Education	$8,675
93.043	Special Programs for the Aging_title Iii, Part D_disease Prevention and Health Promotion Services	$8,478
17.285	Apprenticeship USA Grants	$8,119
93.421	Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nation’s Health	$7,762
15.946	Cultural Resources Management	$6,500
66.608	Environmental Information Exchange Network Grant Program and Related Assistance	$6,094
93.336	Behavioral Risk Factor Surveillance System	$5,943
81.138	State Heating Oil and Propane Program	$5,086
15.517	Fish and Wildlife Coordination Act	$3,079
16.754	Harold Rogers Prescription Drug Monitoring Program	$2,908
16.542	Just Juvenile and Delinquency Prevention	$2,754
93.103	Food and Drug Administration_research	$2,427
93.U03	Food Inspection Contract	$2,419
84.310	Statewide Family Engagement Centers	$2,274
93.777	State Survey and Certification of Health Care Providers and Suppliers (title Xviii) Medicare	$2,178
10.645	Farm to School State Formula Grant	$1,310
66.204	Multipurpose Grants to States and Tribes	$1,241
84.358	Rural Education	$1,234
15.224	Cultural Resource Management	$1,192
15.631	Partners for Fish and Wildlife	$1,035
15.511	Cultural Resources Management	$542
84.424	Student Support and Academic Enrichment Program	$310
16.593	Residential Substance Abuse Treatment for State Prisoners	$94
20.237	Commercial Vehicle Information Systems and Networks	$30
93.301	Small Rural Hospital Improvement Grant Program	$-9,448
93.305	National State Based Tobacco Control Programs	$-25,853

Finding 382452 (2023-050)

AI Summary

Finding Text

Categories

Other Findings in this Audit

Programs in Audit