Finding Text
Finding 2022-001 Federal Agency: U.S. Department of Health and Human Services Federal Program: Medical Assistance Program (Medicaid; Title XIX) ALN: #93.778 Compliance Requirement: Eligibility Type of Finding: Significant Deficiency in Internal Controls over Compliance, Nonmaterial Noncompliance Repeat Finding: Yes - 2021-001, 2020-001 CRITERIA: Title 2 U.S. Code of Federal Regulations Section 200.303 states that the auditee must establish and maintain effective internal control over the federal award that provides reasonable assurance that the auditee is managing the federal award in compliance with federal statutes, regulations, and the terms and conditions of the federal award. CONDITION: The County maintains the computer system which is used to support the eligibility determination process. The Quality Assurance and Training ("QAT") unit reviews three randomly generated cases for each social worker per month. The selected cases are reviewed by the QAT team and notes are made in the quality control system to document any necessary corrections. The system requires the QAT team to enter a review date and a due date. The social worker and manager are notified of the selected case files that require correction. Once the social workers make their corrections, the supervisors review the corrections. It is the County's policy that the social workers make the corrections within 10 days of the QAT unit's review, and the supervisors confirm the corrections within 30 days of the QAT review. During our testing of controls over Eligibility, we sampled 60 case file reviews that were reviewed by the QAT unit during FY 2022 and noted the following: - 20 instances in which the QAT unit found no corrective action necessary. - 28 instances in which the QAT unit noted corrective actions were required and these were remediated within the time period specified by County policy. - 8 instances in which the County?s QAT unit noted corrective actions were required and these were remediated, but not within the time period specified by County policy ? corrections were made and reviewed more than 30 days after the QAT unit?s review ? specifically 33, 33, 35, 36, 42, 56, 61, and 147 days later. - 4 instances in which the County?s QAT unit noted corrective actions were required and had not been remediated at of the time of the audit. CONTEXT: Out of 1,197 reviews performed by the Quality Assurance and Training (QAT) unit during FY22, we tested the timeliness of the corrections made to 60 files. The deficiencies above were noted in 12 of the 60 files tested. QUESTION COSTS: None noted. CAUSE: The County did not follow its policy on when corrective action must occur. EFFECTS: Incomplete case files or case files which do not adhere to the County's policies or procedures increases the risk that the County could provide services to individuals not eligible to receive such services or that individuals could be denied benefits for which they are eligible. RECOMMENDATIONS: We recommend the County adhere to the policies to ensure cases selected for quality review are remediated in a timely manner. Best practices in this regard are within 30 days. VIEWS of RESPONSIBLE OFFICIALS: Management agrees with the finding.