Finding 524285 (2024-005)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2024

Accepted

2025-02-24

Audit: 343481

Organization: Cleveland County (NC)

Auditor: Thompson Price Scott Adams & CO

AI Summary

Core Issue: Inadequate record keeping and case review processes led to incomplete documentation for Medicaid eligibility determinations.
Impacted Requirements: Compliance with 42 CFR 435 is necessary for maintaining proper documentation to support eligibility, including timely requests for information.
Recommended Follow-Up: Conduct internal reviews of files, retrain staff on documentation standards, and ensure all eligibility files include necessary verifications and reconciliations with NC FAST.

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 2024-005 Inadequate Request for Information SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: This is a repeat finding from the immediate previous audit, 2023-006. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. 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. The County agrees with the finding. See Corrective Action Plan in the following section. Section III - Federal Award Findings and Questioned Costs (continued) AL No.: 93.778 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. There were 13 errors 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. We examined 60 cases from of 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 applicants could have been approved for benefits for which they were not eligible.

Corrective Action Plan

Finding 2024-005 Inadequate Request for Information Name of Contact Person: Alice Wilson, Medicaid Program Administrator Corrective Action: Proposed Completion Date: Finding 2024-006 FNS Eligibility Determinations Name of Contact Person: Alice Wilson, FNS Program Administrator Corrective Action: Proposed Completion Date: Section III - Federal Award Findings and Questioned Costs (continued) The county will conduct refresher training on how and when to request information needed that includes when to request The Work Number, OVS,AVS, Property checks and Register of Deeds checks. The county will conduct a targeted second party of cases to check the effectiveness of the refresher training provided. 4/1/2025 Section IV - State Award Findings and Questioned Costs Corrective Action Plan for Finding 2024-002, 2024-003, 2024-004, 2024-005 also apply to State Award Findings. All FNS staff will attend a refresher training where sections 435, 505 and 510 will be reviewed. This training will be conducted by Supervision in FNS with the support of the FNS lead staff. This training will include an outline of the requirement for supporting documentation of eligibility and benefit determinations to include verifications used to support such determination at application and recertification where appropriate. All relatable NC FAST job aids will be reviewed with staff to ensure that functionality within the NCFAST system is followed. 3/1/2025

Other Findings in this Audit

524281 2024-006

Significant Deficiency
524282 2024-002

Significant Deficiency Repeat
524283 2024-003

Significant Deficiency Repeat
524284 2024-004

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