Finding 529241 (2024-008)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2024
Accepted
2025-03-21
Audit: 347266
Organization: Hertford County (NC)

AI Summary

  • Core Issue: Inaccurate resource entries in Medicaid eligibility documentation could lead to ineligible applicants receiving assistance.
  • Impacted Requirements: Record-keeping and case review processes are ineffective, resulting in incomplete documentation and incorrect eligibility determinations.
  • Recommended Follow-Up: Conduct internal reviews of case files, retrain staff on documentation standards, and ensure all verifications align with NC FAST records.

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: 2024-008 Inaccurate Resources 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: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received assistance 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. 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. 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, the countable resources should be calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the verification process should be considered countable or non-countable resources and explained within the documentation. There was 1 error discovered during our procedures where resources were imcorrectly calculated or were not properly documented in 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. This is a repeat finding from the immediate previous audit, 2023-009. Section III. Federal Award Findings and Questioned Costs (continued) 118

Corrective Action Plan

Corrective Action Plan For the Year Ended June 30, 2024 Finding 2024-008 Inaccurate Resources Entry Name of contact person: Corrective Action: Proposed completion date: Ensure staff are well-versed in the policy guidelines, such as MA-2230 Financial Resources, which define what constitutes a resource and what is countable. Use real-world scenarios and examples of correct and incorrect resource entries during staff training sessions. Encourage staff to complete or revisit relevant training modules to strengthen their understanding. Implement resource-specific checklists to guide staff through the entry process, ensuring all required data is verified and documented before submission. Require staff to confirm that resource amounts match the verification provided (e.g., bank statements, property valuations, vehicle assessments). Staff should routinely check determination history to ensure consistency and prevent duplicate or conflicting entries. Encourage staff to validate that resource entries align with other evidence in NC FAST. Require staff to compare manual budget calculations against NC FAST results to ensure accuracy. Conduct regular second-party reviews of resource entries to identify and correct errors before case authorization. Emphasize the importance of accuracy during staff meetings and coaching sessions. Hold staff accountable for errors by requiring signed checklists or certifications of reviewed work for each case. Ensure staff follow up on incomplete or unclear resource verifications in a timely manner to avoid delays or incorrect determinations. Require staff to consistently monitor inbox tasks, Medicaid Verification Reports, and other system alerts to address resource discrepancies promptly. Supervisors will provide one-on-one coaching for staff struggling with resource accuracy, using specific examples from their cases as teaching opportunities. Implement knowledge checks or mini-quizzes after training sessions to reinforce critical points about accurate resource entry. Share common errors and their solutions in unit meetings to create a learning environment focused on improvement. By combining training, tools, oversight, and accountability, the likelihood of inaccurate resource entry can be minimized effectively. Management monitor daily to track progress of this issue and modify the controls as needed. Section III - Federal Award Findings and Question Costs (continued) 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 125

Categories

Eligibility

Other Findings in this Audit

  • 529239 2024-006
    Significant Deficiency Repeat
  • 529240 2024-007
    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