Finding 523978 (2024-007)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2024

Accepted

2025-02-20

Audit: 343198

Organization: Granville County, North Carolina (NC)

Auditor: Thompson Price Scott Adams & CO

AI Summary

Core Issue: Inaccurate information entry in Medicaid eligibility files, leading to potential miscalculations of income and household size.
Impacted Requirements: Compliance with 42 CFR 435 and 2 CFR 200 regarding proper documentation and internal controls for eligibility determinations.
Recommended Follow-Up: Retrain staff on documentation standards, ensure all files include necessary verifications, and conduct internal reviews to improve record-keeping practices.

Finding Text

Granville County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2024 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: 2024-007 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Cost: Context: Effect: Identification of a repeat finding: Cause: Section III - Federal Award Findings and Questioned Costs (Continued) There was no known affect to eligibility and there were no known questioned costs. 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 and 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. 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 2 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. This is a repeat finding from the immediate previous audit, 2023-005. The County agrees with the finding. See Corrective Action Plan in the following section. 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. 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. 172Granville County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2024 Recommendation: Views of responsible officials and planned corrective actions: Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 Section IV - State Award Findings and Questioned Costs The County agrees with the finding. See Corrective Action Plan in the following section. Section III - Federal Award Findings and Questioned Costs (Continued) SIGNIFICANT DEFICENCY: Finding 2024-005, 2024-006, and 2024-007 also apply to State requirements and State Awards. Files should be reviewed internally to ensure all required verifications have been completed and information requested from the applicant/beneficiary or through various systems have been included 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. 173

Corrective Action Plan

For the Year Ended June 30, 2024 Corrective Action Plan Proposed completion date: Finding 2024-006 Inadequate Request for Information Name of contact person: Corrective Action: Proposed completion date: Finding 2024-007 Inaccurate Information Entry Name of contact person: Refresher training will be held by December 31, 2024 on effective documentation and record keeping. “Vehicle Status Documentation” template will be created and implemented by December 31, 2024. Error Trends Data log was implemented October 1, 2024. Adult Medicaid Lead Workers will monitor this by conducting a random selection of second party reviews each month. Adult Income Maintenance Supervisor II (pending vacancy), Delta Elliott, Income Maintenance Lead Worker III, and Michelle Ogle, Income Maintenance Lead Worker III Error discovered where vehicle status was not clearly documented in the case record caused by ineffective record keeping and incomplete documentation. Refresher training will be held by 12/31/2024 to review appropriate documentation and record keeping in NC FAST and will be conducted by Adult Medicaid leadership. Adult Medicaid Supervisor will create a “Vehicle Status Documentation” template that will be utilized by all Adult Medicaid caseworkers at every application and recertification. Completion and uploading of this template will be required in NC FAST. Adult Medicaid Lead Caseworkers will monitor the use of the template during monthly second party reviews of each caseworker. Adult Medicaid Supervisor created and utilized an Error Trends Data log effective 10/1/2024. The Error Trends Data log captures monthly errors to identify trends among staff. This log also provides Adult Medicaid leadership with data regarding errors that are repetitive to help leadership conduct monthly or quarterly refresher training as well as individualized training for staff who continue to have repetitive errors. Staff who fail to utilize the “Vehicle Status Documentation” template and continue to have repetitive errors will be placed on a corrective action plan. Policy refresher training will be held before 12/31/2024 that will cover the IV-D Referral process with specific advisory that the policy is currently suspended until further notice per DHB (Admin Letter 13-23). The Recertification Documentation template was updated on 11/20/2024 and went into effect immediately to be used by all Family and Children’s Medicaid caseworkers. The Error Trends Data log was implemented on October 1, 2024. Family and Children’s Medicaid leadership will monitor this by conducting a random selection of second party reviews each month. Section III - Federal Award Findings and Questioned Costs (continued) Kim Grissom, Income Maintenance Supervisor II; Taylor White, Income Maintenance Supervisor II; Lisa Kornegay, Income Maintenance Lead Worker III; and Sherry Stainback, Income Maintenance Lead Worker III 176Corrective Action Plan For the Year Ended June 30, 2024 Proposed completion date: Corrective actions for Finding 2024-005, 2024-006, and 2024-007 also apply to State Award findings. Errors discovered were income and household composition was calculated incorrectly due to inaccurate information being entered into NCFAST. Family and Children’s Medicaid leadership updated the Recertification Documentation Template on 11/20/2024 to ensure that accurate income, specifically UIB, and household composition is captured and documented appropriately. All Family and Children’s Medicaid caseworkers have been advised to utilize the updated Recertification Documentation Template effective immediately. The Family and Children Medicaid Supervisors created and utilizes an Error Trends Data log effective 10/1/2024. The Error Trends Data log captures monthly errors to identify trends among staff. This log also provides Family and Children Medicaid leadership with data regarding errors that are repetitive to help leadership conduct monthly or quarterly refresher training as well as individualized trainings for staff who continue to have repetitive errors. Staff who fail to utilize the updated Recertification Documentation template and continue to have repetitive errors will be placed on a corrective action plan. Refresher policy training will be held to ensure caseworkers understand policy surrounding income, specifically UIB, and household composition before 12/31/2024. The Recertification Documentation template was updated on 11/20/2024 and went into effect immediately to be used by all Family and Children’s Medicaid caseworkers. The Error Trends Data log was implemented on October 1, 2024. Family and Children’s Medicaid leadership will monitor this by conducting a random selection of second party reviews each month. Section IV - State Award Findings and Questioned Costs Section III - Federal Award Findings and Questioned Costs (continued) 177

Other Findings in this Audit

523976 2024-005

Significant Deficiency
523977 2024-006

Significant Deficiency Repeat
1100418 2024-005

Significant Deficiency
1100419 2024-006

Significant Deficiency Repeat
1100420 2024-007

Significant Deficiency Repeat

Programs in Audit

ALN	Program Name	Expenditures
93.778	Medical Assistance Program	$2.09M
10.561	State Administrative Matching Grants for the Supplemental Nutrition Assistance Program	$848,864
21.027	Coronavirus State and Local Fiscal Recovery Funds	$612,180
93.558	Temporary Assistance for Needy Families	$488,233
93.563	Child Support Services	$480,225
93.658	Foster Care Title IV-E	$305,044
93.667	Social Services Block Grant	$288,038
93.044	Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers	$212,961
93.045	Special Programs for the Aging, Title Iii, Part C, Nutrition Services	$163,268
93.596	Child Care Mandatory and Matching Funds of the Child Care and Development Fund	$130,403
93.767	Children's Health Insurance Program	$120,961
93.568	Low-Income Home Energy Assistance	$95,848
20.513	Enhanced Mobility of Seniors and Individuals with Disabilities	$93,227
21.032	Local Assistance and Tribal Consistency Fund	$80,307
14.228	Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii	$74,793
16.922	Equitable Sharing Program	$63,975
21.016	Equitable Sharing	$46,636
97.042	Emergency Management Performance Grants	$34,839
97.067	Homeland Security Grant Program	$31,463
93.053	Nutrition Services Incentive Program	$27,739
20.600	State and Community Highway Safety	$20,801
93.779	Centers for Medicare and Medicaid Services (cms) Research, Demonstrations and Evaluations	$19,509
93.645	Stephanie Tubbs Jones Child Welfare Services Program	$15,382
93.556	Marylee Allen Promoting Safe and Stable Families Program	$6,859
93.659	Adoption Assistance	$6,588
93.052	National Family Caregiver Support, Title Iii, Part E	$4,453
93.674	John H. Chafee Foster Care Program for Successful Transition to Adulthood	$2,701
45.310	Grants to States	$1,798