Finding 516065 (2024-005)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2024

Accepted

2024-12-19

Audit: 333850

Organization: Edgecombe County (NC)

Auditor: Thompson Price Scott Adams & CO

AI Summary

Core Issue: There was an inaccurate resource calculation in Medicaid eligibility documentation, leading to a significant deficiency.
Impacted Requirements: Compliance with Medicaid Manual MA-2230 was not met, as case records lacked proper verification and documentation.
Recommended Follow-Up: Conduct internal reviews of files, retrain workers on documentation standards, and ensure all records align with NC FAST data.

Finding Text

Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2024-005 Inaccurate Resource Calculation SIGNIFICANT DEFICIENCY ELIGIBILITY Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 cases from of a total of 1,005,637 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-005. Section III. Federal Award Findings (continued) Criteria: In accordance with Medicaid Manual MA-2230, 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. Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer to the corrective action plan for details. Condition: There was 1 error 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. 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.

Corrective Action Plan

Finding: 2024-004 Inaccurate Information Entry Finding: 2024-005 Inaccurate Resource Calculation Finding: 2024-006 Inadequate Request for Information Corrective Action: Application checklist updated to include a list of persons in the household, a line item also added to ask if changes have been applied in NCFAST. A line item was also added to list the children in the home and request for IV-D referral if applicable. Medicaid Supervisors and Quality Control workers will review files internally prior to approval or denial of a case to ensure that verifications match the evidence in NCFAST and changes have been applied to the cases. This will serve as a second check to catch things prior to the case being completed. MA-3300 Income training will be conducted with all workers. Corrective Action: Application checklist updated to include a line item to check to see if the bank account information in evidence matches what shows in determinations. Caseworkers will be trained to enddate old evidence and start a new evidence for a new period to show when the information has been updated. Medicaid Supervisors and Quality Control workers will review files internally to ensure verifications received and put into evidence matches information in determinations once an eligibility check has been ran. They will also ensure that changes have been applied. Proposed Completion Date: Training and implementation of additional reviews and procedures will be implemented by January 15, 2025.

Other Findings in this Audit

516063 2024-003

Significant Deficiency Repeat
516064 2024-004

Significant Deficiency Repeat
516066 2024-006

Significant Deficiency Repeat
516067 2024-007

Significant Deficiency Repeat
1092505 2024-003

Significant Deficiency Repeat
1092506 2024-004

Significant Deficiency Repeat
1092507 2024-005

Significant Deficiency Repeat
1092508 2024-006

Significant Deficiency Repeat
1092509 2024-007

Significant Deficiency Repeat

Programs in Audit

ALN	Program Name	Expenditures
10.760	Water and Waste Disposal Systems for Rural Communities	$6.73M
93.778	Medical Assistance Program	$2.14M
93.563	Child Support Services	$1.12M
93.558	Temporary Assistance for Needy Families	$953,270
10.561	State Administrative Matching Grants for the Supplemental Nutrition Assistance Program	$890,693
93.667	Social Services Block Grant	$456,861
93.658	Foster Care Title IV-E	$405,585
21.027	Coronavirus State and Local Fiscal Recovery Funds	$227,381
10.557	Wic Special Supplemental Nutrition Program for Women, Infants, and Children	$218,798
93.994	Maternal and Child Health Services Block Grant to the States	$200,103
93.045	Special Programs for the Aging, Title Iii, Part C, Nutrition Services	$185,005
93.596	Child Care Mandatory and Matching Funds of the Child Care and Development Fund	$155,560
93.323	Epidemiology and Laboratory Capacity for Infectious Diseases (elc)	$144,892
93.767	Children's Health Insurance Program	$96,928
93.967	Centers for Disease Control and Prevention Collaboration with Academia to Strengthen Public Health	$95,528
93.568	Low-Income Home Energy Assistance	$88,095
93.917	Hiv Care Formula Grants	$65,613
93.217	Family Planning Services	$56,864
97.067	Homeland Security Grant Program	$54,000
93.268	Immunization Cooperative Agreements	$49,668
93.044	Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers	$45,793
16.001	Law Enforcement Assistance Narcotics and Dangerous Drugs Laboratory Analysis	$42,330
97.042	Emergency Management Performance Grants	$39,698
93.069	Public Health Emergency Preparedness	$34,935
93.053	Nutrition Services Incentive Program	$30,703
93.991	Preventive Health and Health Services Block Grant	$29,265
20.600	State and Community Highway Safety	$28,249
16.738	Edward Byrne Memorial Justice Assistance Grant Program	$24,856
93.116	Project Grants and Cooperative Agreements for Tuberculosis Control Programs	$21,327
16.607	Bulletproof Vest Partnership Program	$21,060
93.674	John H. Chafee Foster Care Program for Successful Transition to Adulthood	$11,948
93.659	Adoption Assistance	$6,874
93.645	Stephanie Tubbs Jones Child Welfare Services Program	$5,546
93.556	Marylee Allen Promoting Safe and Stable Families Program	$3,842
93.898	Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations	$380
93.977	Sexually Transmitted Diseases (std) Prevention and Control Grants	$58