Finding 478602 (2023-010)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2023

Accepted

2024-07-16

Audit: 315224

Organization: Hertford County (NC)

Auditor: Thompson Price Scott Adams & CO

AI Summary

Core Issue: Inadequate documentation and record-keeping for Medicaid eligibility, identified as a repeat finding from the previous audit.
Impacted Requirements: Compliance with 42 CFR 435, which mandates proper documentation to support eligibility determinations and electronic matches during applications and redeterminations.
Recommended Follow-Up: Conduct internal reviews of files, retrain staff on documentation standards, and ensure all eligibility files include necessary verifications and clear case notes.

Finding Text

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. The County agrees with the finding. See the response in the corrective action plan.

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.

Other Findings in this Audit

478598 2023-006

Significant Deficiency Repeat
478599 2023-007

Significant Deficiency Repeat
478600 2023-008

Significant Deficiency Repeat
478601 2023-009

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