Finding 507809 (2024-001)

Finding 2024-001 U.S. Department of Health and Human Services Passed through the N.C. Department of Health and Human Services Maternal & Child Health Services Assistance Listing # 93.994 Nonmaterial Noncompliance – Eligibility Criteria: To be eligible for maternal and child health ambulatory services provided by MCH program funds, clients must meet the eligibility criteria established by the local provider. Financial eligibility requirements may not be more restrictive than the official poverty line issued annually by the United States Department of Health and Human Services (10A NCAC 43B.0105). Appropriate fees should be collected from each participant upon each visit to the clinic which are based on the determination of eligibility classification. Condition: Out of 40 case files tested, one case was noted where the fee was properly assessed at 60%, however, was not charged correctly when the participant visited the clinic. Questioned Costs: $60. Context: The participant should have been billed for 60%, or $60, for clinic services. Effect: By not charging the proper fee based on eligibility criteria, the County may be reimbursed for unallowed amounts and may have to return these funds. Cause: A staff member in Central Billing believed the teen clinic was free of charge. Recommendation: We recommend the County ensure caseworkers are receiving necessary training to ensure they are aware of compliance requirements. Management’s Response: Management agrees with the finding and has already provided training to staff that teen clinic services are billable based on income and eligibility requirements.