FAC Explorer

Finding 524283 (2024-003)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2024
Accepted
2025-02-24
Audit: 343481
Organization: Cleveland County (NC)
Auditor: Thompson Price Scott Adams & CO

AI Summary

  • Core Issue: Inaccurate information entry in Medicaid eligibility files, leading to significant deficiencies in record keeping.
  • Impacted Requirements: Compliance with 42 CFR 435 and 2 CFR 200 regarding documentation and internal controls for eligibility determinations.
  • Recommended Follow-Up: Conduct internal reviews of files, retrain staff on documentation standards, and ensure all eligibility files include necessary verifications and clear case notes.

Finding Text

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Medical Assistance Program (Medicaid; Title XIX) Finding 2024-003 Inaccurate Information Entry SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: 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, 2023-004. There was no known affect to eligibility and there were no known questioned costs. 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. 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. AL No.: 93.778 We examined 60 cases from a total of 1,459,263 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. 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.

Corrective Action Plan

Finding 2024-002 IV-D Cooperation with Child Support Name of Contact Person: Alice Wilson, Medicaid Program Administrator Corrective Action: Proposed Completion Date: Finding 2024-003 Inaccurate Information Entry Name of Contact Person: Alice Wilson, Medicaid Program Administrator Corrective Action: Proposed Completion Date: Finding 2024-004 Inaccurate Resources Entry Name of Contact Person: Alice Wilson, Medicaid Program Administrator Corrective Action: Proposed Completion Date: The County recognizes that through our transition in software we have fully reconciled all fixed asset transactions. Going forward, County finance staff will thoroughly track and reconcile all fixed assets annually. Along with reconciliation, the process of purchasing and recoding asset transactions has been modified, to include various checks and balances. Completed 7/1/2024 Section III - Federal Award Findings and Questioned Costs Section II - Financial Statement Findings 4/1/2025 Lead staff along with Supervision will condcut refresher training regarding when and how to properly send a IV D referral. The county must also ensure that staff is aware of current guidance in Admin letter 13-23 which states that an applicant/beneficiary is not required to cooperate with Child Support during the CCU period. While this is a repeat finding it is important to note the decrease in errors found to one error in 2023 compared to 3 found in 2022. The county feels that the specialization model with in the Family & Childrens team has contributed to this reduction and continues to demonstrate the successfullness as the error for 2024 was one error. For the Year Ended June 30, 2024 Corrective Action Plan Staff will receive refresher training on updating the evidence dashboard at redetermination of eligibility that will be conducted by Supervision. The documentation template for Recertifications will also be updated to include a line item for caseworkers to document that the evidence dashboard has been updated. Lead staff will also complete two targeted Quality review checks on a case sampling to gauge if staff are appropriately updating the dashboard. 4/1/2025 All staff will receive refresher training on determining Household size and countable income, including checking the determinations tab on the activated PDC to ensure that all required income and household members are counted. Lead staff will conduct a targeted QC sample to track progress of lowering this error finding over the first quarter of 2025. 4/1/2025

Categories

Eligibility Significant Deficiency Internal Control / Segregation of Duties

Other Findings in this Audit

  • 524281 2024-006
    Significant Deficiency
  • 524282 2024-002
    Significant Deficiency Repeat
  • 524284 2024-004
    Significant Deficiency Repeat
  • 524285 2024-005
    Significant Deficiency Repeat
  • 1100723 2024-006
    Significant Deficiency
  • 1100724 2024-002
    Significant Deficiency Repeat
  • 1100725 2024-003
    Significant Deficiency Repeat
  • 1100726 2024-004
    Significant Deficiency Repeat
  • 1100727 2024-005
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
21.027 Coronavirus State and Local Fiscal Recovery Funds $6.20M
93.778 Medical Assistance Program $3.92M
93.563 Child Support Services $1.81M
93.658 Foster Care Title IV-E $1.70M
93.558 Temporary Assistance for Needy Families $1.45M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $1.29M
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $769,957
93.667 Social Services Block Grant $503,409
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $374,610
93.767 Children's Health Insurance Program $284,845
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $254,315
93.268 Immunization Cooperative Agreements $232,534
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $184,197
93.568 Low-Income Home Energy Assistance $138,099
93.659 Adoption Assistance $98,651
16.710 Public Safety Partnership and Community Policing Grants $92,139
93.217 Family Planning Services $84,250
93.994 Maternal and Child Health Services Block Grant to the States $77,040
16.738 Edward Byrne Memorial Justice Assistance Grant Program $49,756
93.967 Centers for Disease Control and Prevention Collaboration with Academia to Strengthen Public Health $36,251
93.556 Marylee Allen Promoting Safe and Stable Families Program $35,583
97.042 Emergency Management Performance Grants $35,000
93.069 Public Health Emergency Preparedness $31,298
93.991 Preventive Health and Health Services Block Grant $30,431
93.940 Hiv Prevention Activities Health Department Based $28,000
93.645 Stephanie Tubbs Jones Child Welfare Services Program $24,978
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $24,492
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $23,850
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $22,800
93.053 Nutrition Services Incentive Program $22,251
93.436 Well-Integrated Screening and Evaluation for Women Across the Nation (wisewoman) $1,350
93.917 Hiv Care Formula Grants $507
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $100
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $50
93.566 Refugee and Entrant Assistance State/replacement Designee Administered Programs $14