Finding 517116 (2024-002)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2024
Accepted
2024-12-30
Audit: 334995
Organization: Beaufort County (NC)

AI Summary

  • Core Issue: Inaccurate information entry in Medicaid eligibility determinations, leading to potential approvals for ineligible benefits.
  • Impacted Requirements: Non-compliance with documentation standards under 42 CFR 435 and lack of adequate internal controls as per 2 CFR 200.
  • Recommended Follow-Up: Improve record-keeping and case review processes to ensure accurate eligibility determinations and prevent repeat findings.

Finding Text

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: 2024-002 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Section II. Financial Statement Findings (continued) This is a repeat finding from the immediate previous audit, 2023-002. We examined 60 cases from of a total of 607,835 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits 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. Section III. Federal Award Findings and Questioned Costs 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. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. There were 4 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. There was no known affect to eligibility and there were no known questioned costs.

Corrective Action Plan

Finding 2024-002 Name of contact person: Corrective Action: Proposed completion date: Amy Spring, Income Maintenance Administrator Supervisors, will ensure staff complete all required trainings provided by the Division of Health Benefits. Supervisors will provide additional training, when needed to ensure staff have a good understanding of all current and new policy as policy continuously changes. Records will be reviewed internally to ensure cases provide proper documentation. Workers will be trained on the importance of ensuring files include, online verifications, documentation of resources and ensuring, documented resources and income match information entered in NCFAST. Documentation in files should provide clear steps taken by caseworkers to determine eligibility. Checklists have been established to include errors cited during audit. Checklists are to be completed at applications and recertifications, As policy changes and new recommendations are provided by the state, checklists are updated to ensure staff are aware of the most recent policy and procedures. Training will be provided on November 13, 2024 to review findings and corrective action items. Trainings will continue every week, to review policy changes, NCFAST updates as well as common errors that may be found during second party reviews. Our Quality Control Specialist has started second partying records to assist Medicaid supervisors in capturing error trends. As policy changes, throughout the year, it also requires additional training in NCFAST to ensure system procedures align with policy requirements. The Quality Control Specialist will be working with supervisors to ensure staff are knowledgeable of common error trends to prevent reoccurring errors. Errors are listed as Significant Deficiency, but the county continues to show a decrease in errors from previous fiscal years. Fiscal year 2021-2022 there were 21 errors, 2022- 2023 there were 13 and 2023-2024 we have 11 errors. Our staff continue to make every effort to ensure accuracy of eligibility for the citizens of Beaufort County. Although errors may be categorized under the same category of Inaccurate Information Entry, Request for Information and Inaccurate Resource Entry, there are a variable of errors that could classify under these categories. Therefore, previous errors cited under these categories may not always be the exact same errors.

Categories

Eligibility Internal Control / Segregation of Duties

Other Findings in this Audit

  • 517117 2024-003
    Significant Deficiency Repeat
  • 517118 2024-004
    Significant Deficiency Repeat
  • 1093558 2024-002
    Significant Deficiency Repeat
  • 1093559 2024-003
    Significant Deficiency Repeat
  • 1093560 2024-004
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $1.61M
93.558 Temporary Assistance for Needy Families $1.11M
93.658 Foster Care Title IV-E $845,845
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $754,003
93.563 Child Support Services $549,435
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $338,057
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $320,606
93.667 Social Services Block Grant $259,348
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $239,779
93.268 Immunization Cooperative Agreements $239,181
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $224,126
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $131,232
93.092 Affordable Care Act (aca) Personal Responsibility Education Program $126,958
93.767 Children's Health Insurance Program $73,620
93.568 Low-Income Home Energy Assistance $55,185
93.217 Family Planning Services $50,656
21.032 Local Assistance and Tribal Consistency Fund $50,000
93.556 Marylee Allen Promoting Safe and Stable Families Program $46,504
93.967 Centers for Disease Control and Prevention Collaboration with Academia to Strengthen Public Health $40,300
93.994 Maternal and Child Health Services Block Grant to the States $33,920
93.991 Preventive Health and Health Services Block Grant $30,431
93.917 Hiv Care Formula Grants $30,284
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $25,500
14.239 Home Investment Partnerships Program $22,830
97.042 Emergency Management Performance Grants $20,625
93.136 Injury Prevention and Control Research and State and Community Based Programs $20,595
93.053 Nutrition Services Incentive Program $16,836
93.645 Stephanie Tubbs Jones Child Welfare Services Program $11,603
93.069 Public Health Emergency Preparedness $11,553
21.027 Coronavirus State and Local Fiscal Recovery Funds $3,359
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $2,577
93.659 Adoption Assistance $2,078
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $100
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $50
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $43