Finding 518627 (2024-003)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2024
Accepted
2025-01-10
Audit: 337085
Organization: Person County (NC)

AI Summary

  • Core Issue: Inaccurate resource entries and ineffective record-keeping led to a significant deficiency in eligibility determinations for Medicaid.
  • Impacted Requirements: Compliance with Medicaid Manual MA-2230, which mandates proper documentation and verification of resources in case files.
  • Recommended Follow-Up: Conduct internal reviews of files, retrain staff on documentation standards, and ensure all records align with NC FAST data.

Finding Text

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Finding: 2024-003 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. The County agrees with the finding. See Corrective Action Plan in the following section. 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. This is a repeat finding from the immediate previous audit, 2023-002. There were 2 errors discovered during our procedures where resources were incorrectly calculated or were not properly documented in the case file. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 454,445 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. 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 noncountable resources and explained within the documentation. Section III. Federal Award Findings and Questioned Costs (continued) 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.

Corrective Action Plan

Finding: 2024-001 Name of contact person: Corrective Action: Proposed Completion Date: Finding: 2024-002 Name of contact person: Corrective Action: Proposed Completion Date: Tracy Clayton, Interim Chief Financial Officer The prior period adjustment (PPA) errors were primarily due to oversight and misclassification in the application of accounting standards. Specifically, the following factors contributed to these adjustments: Unrecorded Liabilities: The omission of salaries payable in the General Fund and Person Industries was due to a reconciliation error of accrued expenses at year-end, which led to unrecorded liabilities as of June 30, 2023. Misclassification of Capital Project Expenses: In the Stormwater Fund and Governmental Activities, some project-related expenses were misclassified as expenses instead of being capitalized as Construction in Process. This misclassification occurred due to an unclear review of project expenditures and the criteria for capitalization, which led to discrepancies in how capital assets were presented. Lessor Agreement Adjustments: The failure to initially record certain lease receivables and deferred inflows under GASB 87 in prior years was due to a misunderstanding in implementing new accounting standards. To prevent future occurrences, we will strengthen internal controls, revise reporting procedures, and enhance staff training. Imminently. Corrective Action Plan For the Year Ended June 30, 2024 Section II - Financial Statement Findings Brittany Majors (Medicaid Manager) and Diane Oakley (Medicaid Supervisor) We have been conducting regular income training since March 2023. We have had a great deal of turn over within our staff. Therefore we have conducted regular income trainings ever since. We now have a Staff Development team in place for one on one trainings, and group trainings as well. We also on 09/01/2024 implemented new documentation outlines, coversheets, and checklist to assist our staff with ensuring they verify and address all things needed to properly evaluate a case. We have increased the number of second party case reviews that we do each month to try and catch error trends so that they maybe addressed quickly. Staff development positions began for F & C Unit in May 2024, and for Adult Medicaid in June 2024 SSI case reassignments were restructured May 2024. Staff trainings for Second Party errors are now completed on a monthly basis. If one person seems to be struggling one on one trainings are scheduled as well. All new forms and outlines began 09/01/2024.

Categories

Eligibility

Other Findings in this Audit

  • 518626 2024-002
    Significant Deficiency Repeat
  • 518628 2024-004
    Significant Deficiency Repeat
  • 518629 2024-005
    Significant Deficiency Repeat
  • 518630 2024-006
    Significant Deficiency
  • 1095068 2024-002
    Significant Deficiency Repeat
  • 1095069 2024-003
    Significant Deficiency Repeat
  • 1095070 2024-004
    Significant Deficiency Repeat
  • 1095071 2024-005
    Significant Deficiency Repeat
  • 1095072 2024-006
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $1.81M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $816,659
93.658 Foster Care Title IV-E $606,445
93.563 Child Support Services $547,524
93.667 Social Services Block Grant $373,797
93.558 Temporary Assistance for Needy Families $275,869
20.509 Formula Grants for Rural Areas and Tribal Transit Program $224,988
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $218,810
16.922 Equitable Sharing Program $147,247
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $133,449
93.767 Children's Health Insurance Program $118,228
93.268 Immunization Cooperative Agreements $97,541
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $92,365
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $86,155
97.137 State and Local Cybersecurity Grant Program Tribal Cybersecurity Grant Program $77,780
93.217 Family Planning Services $46,450
93.568 Low-Income Home Energy Assistance $45,288
93.069 Public Health Emergency Preparedness $31,668
93.991 Preventive Health and Health Services Block Grant $30,431
16.607 Bulletproof Vest Partnership Program $25,503
16.738 Edward Byrne Memorial Justice Assistance Grant Program $23,519
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $18,243
93.645 Stephanie Tubbs Jones Child Welfare Services Program $11,283
93.053 Nutrition Services Incentive Program $11,136
93.659 Adoption Assistance $3,920
21.027 Coronavirus State and Local Fiscal Recovery Funds $3,509
93.994 Maternal and Child Health Services Block Grant to the States $2,562
93.042 Special Programs for the Aging, Title Vii, Chapter 2, Long Term Care Ombudsman Services for Older Individuals $1,376
93.052 National Family Caregiver Support, Title Iii, Part E $1,050
93.917 Hiv Care Formula Grants $594
93.556 Marylee Allen Promoting Safe and Stable Families Program $116
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $100
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $50