FAC Explorer

Finding 45892 (2022-001)

Significant Deficiency
Requirement
NP
Questioned Costs
-
Year
2022
Accepted
2023-01-17
Audit: 41619
Organization: Wilson County, North Carolina (NC)
Auditor: Martin Starnes & Associates CPAS P A

AI Summary

  • Core Issue: A significant deficiency was found in maintaining adequate case documentation for claims entered into the EPI system, affecting the validity of claims.
  • Impacted Requirements: Compliance with North Carolina DSS Crosscutting Requirements, specifically the need for proper documentation to substantiate claims.
  • Recommended Follow-Up: County DSS staff should enhance controls to ensure all documentation is accurate and aligns with entries in the EPI system.

Finding Text

U.S. Department of Health and Human Services Passed through the N.C. Department of Health and Human Services, Division of Social Services Program Name: DSS Crosscutting (State) Medicaid Cluster AL#93.778 (XIX-MAP22) Temporary Assistance for Needy Families (TANF) State Program AL#93.558 (2201NCTANF) Foster Care, Adoption, and Guardianship Assistance Program Cluster AL#93.659 (2201NCADPT) and AL# 93.658 (2201NCFOST) Finding: 2022-001 Significant Deficiency, non-material non-compliance Special Tests and Provisions (Enterprise Program Integrity) Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (?EPI?) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment. Condition: We noted one instance of a Food and Nutrition Services claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County. Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile. Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result. Cause: Documentation to support a claim entered into EPI was not accurate. Questioned Costs: None, no payments have been collected by the County to date on this claim. Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI. Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.

Corrective Action Plan

Corrective Action Plan For the Year Ended June 30, 2022 Finding: 2022-001 Jessica Murphy, Team Leader, Special Investigations Significant Deficiency, nonmaterial noncompliance Special Tests and Provisions (Enterprise Program Integrity) Per the North Carolina DSS Crosscutting Requirements compliance supplement, counties must acquire case documentation to substantiate the claim entry into the NC FAST Enterprise Program Integrity (?EPI?) system, including the budget and budget calculation sheets used to compute the amount of the overpayment. In one stance of a Food and Nutrition Services claim entered in EPI, there was not adequate case documentation to substantiate the claim and the budget calculated during the initial investigation in the claims file did not agree to the amount that was entered in EPI to be collected on by the county. This claim has since been reviewed, the budget was corrected and the amount in the EPI system, as well as the casefile, was updated. In order to prevent subsequent instances of this issue occurring, DSS Program Integrity staff will implement the following internal control measures effective 1/1/2023: ? Review and evaluate current DSS-1682 Report of Erroneous Issuance form for errors and miscalculations. In reviewing the case in which the error occurred, it was discovered that the DSS-1682 had a formula error in which the amounts did not total correctly on the spreadsheet. Therefore, the incorrect overpayment amount was entered into the EPI system. The DSS-1682 will be reviewed and updated to show the correct formula calculations and the previously-used incorrect form will be removed from usage by staff by 12/31/22. ? Additional second-party and third-party reviewing processes for overpayment claims. In the identified case finding, a second-party review was completed, as are all overpayment claims per Food and Nutrition Services policy, however this instance revealed that additional review, in the form of a third-party can provide a reduced risk-factor as the error could have been discovered by the additional review. Effective 1/1/23, all overpayment claims must be submitted for second-party review and third-party review prior to submission into the NC FAST EPI system. ? Revised case review tools. There is currently not a detailed, itemized review form that is used for Program Integrity. The current tool does have specifications for the evaluation of the overpayment calculation; however, it does not have additional indicators to allow for consistency in reviewing the specified overpayment months, program integrity budgets, financial transactions, and correct allotment amounts. In observation of this, it has been determined that a new case record review tool will be created and implemented effective 1/1/23. The proposed effect of this form will be that additional review and inquiry will be completed by the second party reviewer and the third-party reviewer and there will be increased compliance in regards to overpayment claim calculation. The planned controls have the projected effect of reducing the risk of overpayment calculation errors, incorrect budgeting, and invalid claim amounts entered into the NC FAST EPI system. Proposed completion: All measures effective 1/1/23 and ongoing.

Categories

Special Tests & Provisions Significant Deficiency

Other Findings in this Audit

  • 45893 2022-001
    Significant Deficiency
  • 45894 2022-001
    Significant Deficiency
  • 45895 2022-001
    Significant Deficiency
  • 45896 2022-001
    Significant Deficiency
  • 45897 2022-001
    Significant Deficiency
  • 45898 2022-001
    Significant Deficiency
  • 45899 2022-001
    Significant Deficiency
  • 45900 2022-001
    Significant Deficiency
  • 45901 2022-001
    Significant Deficiency
  • 45902 2022-001
    Significant Deficiency
  • 45903 2022-001
    Significant Deficiency
  • 622334 2022-001
    Significant Deficiency
  • 622335 2022-001
    Significant Deficiency
  • 622336 2022-001
    Significant Deficiency
  • 622337 2022-001
    Significant Deficiency
  • 622338 2022-001
    Significant Deficiency
  • 622339 2022-001
    Significant Deficiency
  • 622340 2022-001
    Significant Deficiency
  • 622341 2022-001
    Significant Deficiency
  • 622342 2022-001
    Significant Deficiency
  • 622343 2022-001
    Significant Deficiency
  • 622344 2022-001
    Significant Deficiency
  • 622345 2022-001
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
21.027 Coronavirus State and Local Fiscal Recovery Funds $7.94M
93.568 Covid-19 - Low-Income Home Energy Assistance - Arpa $788,054
93.568 Covid-19 - Low-Income Home Energy Assistance $731,048
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $680,510
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $567,149
93.667 Social Services Block Grant $555,586
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $310,284
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $143,224
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $139,545
93.268 Covid-19 - Immunization Cooperative Agreements $135,348
93.568 Covid-19 - Low-Income Home Energy Assistance - Caa $132,470
93.658 Foster Care_title IV-E $120,680
93.568 Low-Income Home Energy Assistance $114,513
93.778 Medical Assistance Program $104,238
93.556 Marylee Allen Promoting Safe and Stable Families $103,368
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $100,377
93.659 Adoption Assistance $89,294
93.767 Children's Health Insurance Program $84,021
93.994 Maternal and Child Health Services Block Grant to the States $83,674
93.217 Family Planning_services $60,788
45.310 Grants to States $59,072
93.569 Community Services Block Grant $39,016
97.042 Emergency Management Performance Grants $36,150
93.053 Nutrition Services Incentive Program $35,278
93.069 Public Health Emergency Preparedness $34,651
10.561 Covid-19 - State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $33,840
20.509 Covid-19 - Formula Grants for Rural Areas and Tribal Transit Program $33,458
93.645 Stephanie Tubbs Jones Child Welfare Services Program $30,240
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $27,283
93.268 Immunization Cooperative Agreements $24,578
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $23,511
93.991 Preventive Health and Health Services Block Grant $23,197
16.922 Equitable Sharing Program $21,865
16.606 State Criminal Alien Assistance Program $19,994
93.558 Temporary Assistance for Needy Families $19,584
16.607 Bulletproof Vest Partnership Program $13,406
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $12,644
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $9,149
93.563 Child Support Enforcement $7,797
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $6,500
93.103 Food and Drug Administration_research $6,096
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $3,416
20.509 Formula Grants for Rural Areas and Tribal Transit Program $1,522
93.977 Preventive Health Services_sexually Transmitted Diseases Control Grants $100