Finding 529240 (2024-007)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2024

Accepted

2025-03-21

Audit: 347266

Organization: Hertford County (NC)

Auditor: Thompson Price Scott Adams & CO

AI Summary

Core Issue: There were errors in eligibility determinations for the Medical Assistance Program due to inaccurate information entry.
Impacted Requirements: Compliance with 42 CFR 435 and 2 CFR 200 regarding documentation and internal controls for eligibility assessments.
Recommended Follow-Up: Conduct internal reviews of case files, retrain staff on documentation standards, and ensure all eligibility files include necessary verifications.

Finding Text

Hertford County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2024 US Department of Health and Human Services Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL# 93.778 Finding: 2024-007 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective 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 3 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 353,314 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. This is a repeat finding from the immediate previous audit, 2023-008. 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 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. The County agrees with the finding. See the response in the corrective action plan. Section III. Federal Award Findings and Questioned Costs (continued) 117

Corrective Action Plan

Corrective Action Plan For the Year Ended June 30, 2024 Finding 2024-007 Inaccurate Information Entry Name of contact person: Corrective Action: Proposed completion date: Section III - Federal Award Findings and Question Costs (continued) Management monitor daily to track progress of this issue and modify the controls as needed. Monthly second-party reviews will continue to be conducted to ensure accuracy in case processing. Peer-to-peer second-party reviews will be implemented monthly to encourage collaborative oversight. Staff will be required to perform second-party reviews of their own recertifications to reinforce attention to detail. Application checklists will be utilized for all applications and recertifications to verify that staff collect and verify the correct data needed for processing. Staff will complete and sign checklists for every application and recertification, holding them accountable for accuracy and thoroughness. All staff have been and will continue to be trained on MA-2230 Financial Resources, including identifying resources and determining which are countable. Facilitated trainings on properties, resources, and vehicles will continue to be conducted. Staff will revisit Learning Gateway trainings as needed to reinforce understanding and compliance. Knowledge checks will be incorporated into all trainings to evaluate staff comprehension. Staff will be trained on the importance of completing and utilizing vehicle forms during both applications and recertifications. Staff are encouraged to consistently review determination history prior to case authorization to ensure household composition and income are accurate. NC FAST will be reviewed during applications and recertifications to verify vehicle information and other resources. Staff will confirm that all case files include online verifications, documented resources and income, and that the amounts agree with information in NC FAST. Documentation in case notes will clearly indicate the actions performed and their results. Supervisors will continue to meet with staff individually for coaching sessions to address findings and collaboratively discuss areas for improvement. Supervisors will emphasize the importance of accuracy and accountability in case processing during regular team discussions. Staff will now be held to a higher level of accountability with signed checklists serving as verification of completed work. This plan will ensure consistent improvement in case accuracy and processing while fostering accountability and professional growth among staff. Tiffiany Walton, Interim Director Melissa Castelow, F&C Medicaid Supervisor Anetre Vaughan, Adult Medicaid Supervisor BUILD YOUR FUTURE ON OUR FOUNDATION 115 Justice Drive  Suite 1  Winton, North Carolina 27986 Office 252.358.7805  Facsimile 252.358.0198  www.HerfordCountyNC.gov 124

Other Findings in this Audit

529239 2024-006

Significant Deficiency Repeat
529241 2024-008

Significant Deficiency Repeat
529242 2024-009

Significant Deficiency Repeat
1105681 2024-006

Significant Deficiency Repeat
1105682 2024-007

Significant Deficiency Repeat
1105683 2024-008

Significant Deficiency Repeat
1105684 2024-009

Significant Deficiency Repeat

Programs in Audit

ALN	Program Name	Expenditures
93.778	Medical Assistance Program	$1.25M
21.027	Coronavirus State and Local Fiscal Recovery Funds	$724,185
10.561	State Administrative Matching Grants for the Supplemental Nutrition Assistance Program	$461,253
93.563	Child Support Services	$298,902
93.045	Special Programs for the Aging, Title Iii, Part C, Nutrition Services	$157,518
93.667	Social Services Block Grant	$148,471
93.596	Child Care Mandatory and Matching Funds of the Child Care and Development Fund	$83,719
93.658	Foster Care Title IV-E	$81,553
93.568	Low-Income Home Energy Assistance	$80,849
93.044	Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers	$67,799
93.767	Children's Health Insurance Program	$55,519
97.042	Emergency Management Performance Grants	$39,698
93.053	Nutrition Services Incentive Program	$17,001
93.323	Epidemiology and Laboratory Capacity for Infectious Diseases (elc)	$2,924
93.558	Temporary Assistance for Needy Families	$1,960
93.659	Adoption Assistance	$1,066
93.566	Refugee and Entrant Assistance State/replacement Designee Administered Programs	$106