Finding 526562 (2024-001)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2024
Accepted
2025-03-11
Audit: 345504
Organization: Pasquotank County (NC)

AI Summary

  • Core Issue: Eleven technical errors were found in Medicaid case records, indicating that documentation did not match the NC FAST system, affecting eligibility verification.
  • Impacted Requirements: Documentation must include accurate resource calculations, compliance components, and budget calculations to ensure eligibility determinations are valid.
  • Recommended Follow-Up: Conduct internal reviews of case files, retrain staff on documentation standards, and ensure all resources are verified and accurately recorded in NC FAST.

Finding Text

Criteria: 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. documentation should he present and agree back to the records in the NC FAST system. Any Items discovered In the process should be considered resources and explained within the documentation. Condition: There were eleven (11) technical errors discovered during our procedures that resoum,s ill th• county documentation and those same resources contalned in NC FAST were not the same amounts or files containing resources were not properly documei1ted to be considered countable or non-countable. The errors were as follows: Three (3) rases had a failure to complete at least one compliance component or were improperly forced, two (2) cases lacked substantiating documentation and/or inaccurate resource calculations, four (4) cases did not have accurate budget calculations, and two {2) cases had Inaccurate needs t1nit calculations. Questioned Costs, There was no affect to eligibility and there were no questioned costs. Context: We examined 60 Medkald transactions out of 442,357 to re-determine eligibility Medicaid daims from the Medicaid beneficiary report provided by the NC Department of Health and Human Services. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Servicesand are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: Por those certifications/re•certilications there was a chance that information was not properly documented and reconciled to NC PAST which affect countable resource and a participant could have been approved for benefits that they were not eligible. Cause: Ineffective record keeping and ineffective case review process, Incomplete documentation, and incorrect application ofrutes for purposes of determining eligibility. ldentlficallon ora repeat finding, This is a repeat finding from the Immediate previous audit, 2023-001. Recommendation: Flies should be reviewed internally to ensure proper documentation is in place for eligiblllty. Worlrors should he retrained on what files should contain and the Importance of complete and accurate record keeping. We recommend that all files Include online verifications, dornmented resources of Income and those amounts agree to information in NC FAST. Views ofrespouslble officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support ellglblllty determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations.

Corrective Action Plan

The State provided the DHB-7078 - 2nd Party Review Worksheet which separated evaluation for applications and recertifications. The internal worksheet was expanded to include a weighted score for monitoring error trends and patterns for individual staff and the unit as a whole. The enhanced review sheet allows for measuring improvement and determining where additional training is needed. Supervisors complete second party reviews monthly for all staff, hold individual worker conferences monthly to review discrepancies discovered providing instruction as needed. NCF AST Learning Gateway will be utilized if a specified training is available. Targeted training/instruction is provided during monthly team meetings to review errors and provide guidance and instruction to staff for policy and NC FAST functionality updates. Based on the summary of findings for this fiscal year's audit, a Single County Audit (SCA) Case Review Checklist will be created and utilized to address worker processes and functionality concerns in NC FAST surrounding the categories identified - income, resources and household composition. Targeted reviews will be completed using case records for the months of December 2024, January 2025, February 2025 and March 2025. The enhance·d second party review worksheet (DHB-7078) will continue to be utilized as an ongoing practice with review of findings to be conducted individually with staff and at each monthly unit meeting. By December 20, 2024, a summary of audit errors will be provided to all Medicaid caseworkers along with an outline of corrective actions to be completed as indicated in this plan. SCA Case Review Checklist created to address specific areas identified. (COMPLETE). Targeted case reviews using the SCA Checklist will be completed monthly (December 2024 - March 2025) by designated staff and reviewed individually with caseworkers, as needed. During monthly unit meetings scheduled in January 2025 -April 2025, errors and findings from the actions outlined in this plan will be shared and reviewed with all Medicaid workers.

Categories

Eligibility

Other Findings in this Audit

  • 526563 2024-002
    Significant Deficiency
  • 1103004 2024-001
    Significant Deficiency Repeat
  • 1103005 2024-002
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $1.88M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $756,994
93.558 Temporary Assistance for Needy Families $608,011
93.563 Child Support Services $414,727
93.767 Children's Health Insurance Program $130,120
93.667 Social Services Block Grant $118,654
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $100,252
93.658 Foster Care Title IV-E $80,288
97.042 Emergency Management Performance Grants $60,323
97.067 Homeland Security Grant Program $58,380
93.568 Low-Income Home Energy Assistance $51,706
16.710 Public Safety Partnership and Community Policing Grants $50,120
21.032 Local Assistance and Tribal Consistency Fund $50,000
16.039 Rural Violent Crime Initiative $38,681
97.039 Hazard Mitigation Grant $8,894
16.999 FBI Eastern Nc Safe Streets Task Force $8,839
16.999 Patrick Leahy Bulletproof Vest Partnership $8,355
93.659 Adoption Assistance $7,270
93.645 Stephanie Tubbs Jones Child Welfare Services Program $4,643
93.556 Marylee Allen Promoting Safe and Stable Families Program $1,451
16.111 FBI Organized Crime Drug Enforcement Task Force $416
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $337