Finding 477867 (2023-010)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2023

Accepted

2024-07-08

Audit: 314504

Organization: Vance County (NC)

Auditor: Thompson Price Scott Adams & CO

AI Summary

Core Issue: There were discrepancies between resource documentation in county files and the NC FAST system, leading to potential eligibility concerns.
Impacted Requirements: Compliance with Medicaid Manual MA-2230, which mandates accurate documentation and reconciliation of resources for eligibility determinations.
Recommended Follow-Up: Conduct internal reviews of files, retrain staff on documentation standards, and ensure all records include verifications that align with NC FAST data.

Finding Text

U.S. Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2023-010 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Cause: Identification of a repeat finding: Recommendation: Views of responsible officials and planned corrective actions: There were 1 errors discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 804,789 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. 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. In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application and these items will agree to reports in the NC FAST system. In this process, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or noncountable resources and explained within the documentation. Section III. Federal Award Findings and Questioned Costs (continued) Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. This is a repeat finding from the immediate previous audit, 2022-006. The County agrees with the finding. 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.

Corrective Action Plan

Finding 2023-009 Name of contact person: Corrective Action: Proposed Completion Date: Finding 2023-010 Name of contact person: Corrective Action: Proposed Completion Date: Finding 2023-011 Name of contact person: Corrective Action: Proposed Completion Date: Finding 2023-012 Name of contact person: Corrective Action: Proposed Completion Date: Corrective Action Plan for Finding 2023-008, 2023-009, 2023-010, 2023-011, 2023-012 also apply to State Awards findings. Refresher training on required verification at recertification for Adult and Family & Children process will be completed. The training will include specifically when to send 20020 for Family & Children’s Medicaid. 2nd Party reviews will continue to be completed. February 28, 2024 and ongoing. March 31, 2024 and ongoing. Section IV - State Award Findings and Question Costs Aggressive monitoring of SSI Term Report. Management will continue to monitor the progress of this issue and modify the controls as needed. Goldie Davis, IM Program Manager Goldie Davis, IM Program Manager Goldie Davis, IM Program Manager Goldie Davis, IM Program Manager Training on resources policy and correct entry of evidence in NCFAST. Continued 2nd parties by supervisor. One-on-one supervisory conferences. Monthly refresher trainings in unit meetings addressing error trends. February 20, 2024 and ongoing. Refresher training for staff will be conducted on correct completion of Documentation Template ensuring information verified is documented correctly and evidence updated accurately on case. Continued 2nd parties by supervisor. One-on-one supervisory conferences. Monthly refresher trainings in unit meetings addressing error trends.

Other Findings in this Audit

477864 2023-007

Significant Deficiency
477865 2023-008

Significant Deficiency Repeat
477866 2023-009

Significant Deficiency Repeat
477868 2023-011

Significant Deficiency Repeat
477869 2023-012

Significant Deficiency Repeat
1054306 2023-007

Significant Deficiency
1054307 2023-008

Significant Deficiency Repeat
1054308 2023-009

Significant Deficiency Repeat
1054309 2023-010

Significant Deficiency Repeat
1054310 2023-011

Significant Deficiency Repeat
1054311 2023-012

Significant Deficiency Repeat

Programs in Audit

ALN	Program Name	Expenditures
21.027	Coronavirus State and Local Fiscal Recovery Funds	$2.25M
93.778	Medical Assistance Program	$1.38M
10.561	State Administrative Matching Grants for the Supplemental Nutrition Assistance Program	$747,788
93.568	Low-Income Home Energy Assistance	$720,596
93.558	Temporary Assistance for Needy Families	$392,319
93.667	Social Services Block Grant	$355,409
93.658	Foster Care_title IV-E	$206,987
93.563	Child Support Enforcement	$194,507
93.596	Child Care Mandatory and Matching Funds of the Child Care and Development Fund	$171,400
93.045	Special Programs for the Aging_title Iii, Part C_nutrition Services	$152,960
93.044	Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers	$82,937
93.659	Adoption Assistance	$40,481
97.042	Emergency Management Performance Grants	$39,032
16.738	Edward Byrne Memorial Justice Assistance Grant Program	$30,771
93.767	Children's Health Insurance Program	$16,869
93.053	Nutrition Services Incentive Program	$16,531
93.645	Stephanie Tubbs Jones Child Welfare Services Program	$10,627
93.674	John H. Chafee Foster Care Program for Successful Transition to Adulthood	$10,209
93.052	National Family Caregiver Support, Title Iii, Part E	$4,239
93.556	Promoting Safe and Stable Families	$2,591
93.566	Refugee and Entrant Assistance_state Administered Programs	$18