Finding 478601 (2023-009)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2024-07-16
Audit: 315224
Organization: Hertford County (NC)

AI Summary

  • Core Issue: Inaccurate documentation and record-keeping in Medicaid eligibility processes, leading to repeat findings from previous audits.
  • Impacted Requirements: Compliance with federal regulations for maintaining accurate eligibility documentation and conducting electronic verifications.
  • Recommended Follow-Up: Retrain staff on documentation standards and ensure all files include necessary verifications and reconciliations with NC FAST.

Finding Text

Cause: Recommendation: Views of responsible officials and planned corrective actions: 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) AL# 93.778 Finding: 2023-009 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: 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. Section III. Federal Award Findings and Questioned Costs (continued) For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received assistance for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. The County agrees with the finding. See the response in the corrective action plan. 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 non-countable resources and explained within the documentation. There were 5 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 305,518 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. This is a repeat finding from the immediate previous audit, 2022-010. Recommendation: Views of responsible officials and planned corrective actions: 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) AL# 93.778 Finding: 2023-010 Inadequate Request for Information SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: 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. The County agrees with the finding. See the response in the corrective action plan. This is a repeat finding from the immediate previous audit, 2022-011. 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. Section III. Federal Award Findings and Questioned Costs (continued) For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received assistance for which they were not eligible. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. 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. There were 24 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 305,518 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.

Corrective Action Plan

Finding 2023-009 Inaccurate Resources Entry Name of contact person: Corrective Action: Proposed completion date: Finding 2023-010 Inadequate Request for Information Name of contact person: Corrective Action: Proposed completion date: Caseworkers will undergo periodic retraining sessions to refresh their understanding and ensure compliance with form 5097 usage guidelines. The Medicaid Supervisors and Quality Assurance (QA) staff will review denial at least 3 days each week. Caseworkers are to use the application checklist for every application processed. Caseworkers are reminded to continue following the guidelines outlined in MA-2300: Section XI, which deals with requesting information from applicants, with specific attention is given to parts A.1-5 of the section, focusing on the procedures and documentation required when information is requested from applicants. Management monitor daily to track progress of this issue and modify the controls as needed. Section III - Federal Award Findings and Question Costs (continued) Brenda Brown, Director; Melissa Castelow, Medicaid Supervisor; Satonya Gonzales, Medicaid Supervisor Brenda Brown, Director; Melissa Castelow, Medicaid Supervisor; Satonya Gonzales, Medicaid Supervisor Caseworkers will undergo periodic retraining sessions to refresh their understanding and ensure compliance with form 5097 usage guidelines. The Adult Medicaid Supervisor and Quality Assurance (QA) staff will review denial at least 3 days each week. Caseworkers are to use the application checklist for every application processed. Caseworkers are reminded to continue following the guidelines outlined in MA-2300: Section XI, which deals with requesting information from applicants, with specific attention is given to parts A.1-5 of the section, focusing on the procedures and documentation required when information is requested from applicants. Management monitor daily to track progress of this issue and modify the controls as needed.

Categories

Eligibility

Other Findings in this Audit

  • 478598 2023-006
    Significant Deficiency Repeat
  • 478599 2023-007
    Significant Deficiency Repeat
  • 478600 2023-008
    Significant Deficiency Repeat
  • 478602 2023-010
    Significant Deficiency Repeat
  • 478603 2023-011
    Significant Deficiency
  • 1055040 2023-006
    Significant Deficiency Repeat
  • 1055041 2023-007
    Significant Deficiency Repeat
  • 1055042 2023-008
    Significant Deficiency Repeat
  • 1055043 2023-009
    Significant Deficiency Repeat
  • 1055044 2023-010
    Significant Deficiency Repeat
  • 1055045 2023-011
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
21.027 Coronavirus State and Local Fiscal Recovery Funds $2.21M
93.778 Medical Assistance Program $1.03M
93.568 Low-Income Home Energy Assistance $496,195
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $464,194
93.563 Child Support Enforcement $319,854
93.667 Social Services Block Grant $195,542
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $192,466
97.042 Emergency Management Performance Grants $117,827
93.558 Temporary Assistance for Needy Families $99,105
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $71,310
93.658 Foster Care_title IV-E $49,673
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $30,049
93.053 Nutrition Services Incentive Program $17,117
93.659 Adoption Assistance $14,282
93.767 Children's Health Insurance Program $2,880
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $1,110
93.645 Stephanie Tubbs Jones Child Welfare Services Program $72