Finding 50529 (2022-005)

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) CFDA #: 93.778 Finding: 2022-5 MATERIAL WEAKNESS DSS Crosscutting Requirements for Reporting Criteria: Employee timesheets for in-home aides? payroll should be completed timely and completely so all time is properly approved for payroll and included in the monthly 1571 report submitted to the State. All time included on the report should be supported by documentation within the casefiles or other documentation maintained by the County. Also, Day Sheets are completed for all client-facing employees to document the time spent spent working on cases and what the work that was done. All work should be accurately recorded and recorded to the correct client. Condition: We noted that the report submitted to the reporting officer did not match the manual time sheets filled out by the in-home aides for the time worked by salaried and hourly in-home aides. Time was not documented properly for administrative time on their manual time sheets. All discrepancies were around the documentation of administrative or paid time off and what was documented on the in-home aides? time sheets differed from what was on the Day Sheet. Questioned Costs: None. Finding relates to reporting criteria. As the time reported on the 1571 did agree, there are no questioned costs. Context: We reviewed in-home payroll. Out of the 3 in-home aides we reviewed, all had issues with their time sheets. For caseworkers, we selected 4 cases each for 10 employees. All caseworkers were able to provide justification for time listed. Effect: Time included on the employee?s signed time sheet but not included on the Daysheet and thus the 1571 report creates an issue in the County being able to properly track things such as benefits since many times the time that was underreported were in the areas of vacation and sick leave. Reporting of time worked on the 1571 by Caseworkers for work performed on cases that cannot be supported may lead to reimbursements for work that was not actually performed or that cannot be reperformed since the documentation is missing. Identification of a repeat finding: This is a repeat finding from previous audits, 2021-6, 2020-2, and 2019-2. Cause: Ineffective review of the timesheets. Timesheets for all full-time employees should account for a full work week and be approved by a supervisor. Recommendation: We recommend that employees ensure that there is support maintained in files to support the work performed and claimed on their time sheets. The County should continue to implement the review process started during this fiscal year of the timesheets for in-home aides where a sample is taken monthly to review support for the time claimed on the timesheets to verify that in-home aides are reporting time accurately and completely and that required support is being maintained. Administration should also review the program to determine that most effective and efficient resource allocation is being utilized to service the clients in the program. The review process started with the in-home aides should be considered for expansion to other areas for review of Daysheets to ensure accurate reporting of time on the Daysheets monthly. Overall, for this fiscal year, there was some improvement seen in the area of in-home aide time sheet tracking but with the administrative time there were still issues between the manual time sheet and the Daysheet of information being transferred and reconciled between the two. The worker seems to be more conscientious about recording all of their time and not just their field time but now the reconciliation between the two reports needs to be improved and tightened up. Views of responsible officials and planned corrective actions: Employees will be provided a refresher training on documentation of time sheets. Supervisors will be provided training on the review and reconciliation of data between the timesheet and the daysheet.