Finding 523976 (2024-005)

Granville County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2024 Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medicaid Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2024-005 Non-cooperation with IV-D Referrals SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Cost: Context: Effect: Identification of a repeat finding: The County agrees with the finding. See Corrective Action Plan in the following section. Section II - Financial Statement Findings (continued) Unapproved and ineligible purchases could be made, and the County’s DSS-1571 reimbursement could be overstated. Ineffective record keeping and ineffective purchasing process, incomplete documentation, and incorrect application of rules for computer equipment/services management. Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when making such purchases. Copies of the filed Computer Equipment Acquisition Plan and NCDHHS approval memorandum should be retained and regularly reviewed. In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 3 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 576,600 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. Section III - Federal Award Findings and Questioned Costs This is a repeat finding from the immediate previous audit, 2023-002. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible. 170Granville County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2024 Cause: Recommendation: Views of responsible officials and planned corrective actions: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medicaid Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2024-006 Inadequate Request for Information SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Cost: Context: Effect: Identification of a repeat finding: Cause: Section III - Federal Award Findings and Questioned Costs (Continued) Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. There was 1 error discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. There was no known affect to eligibility and there were no known questioned costs. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible. This is a repeat finding from the immediate previous audit, 2023-004. We examined 60 cases from of a total of 576,600 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. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determining eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. The County agrees with the finding. See Corrective Action Plan in the following section. 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. Electronic matches are required at applications and redeterminations. 171