Finding 529242 (2024-009)

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

AI Summary

  • Core Issue: Inadequate documentation and record-keeping led to potential eligibility errors in Medicaid applications, risking federal funds being given to ineligible recipients.
  • Impacted Requirements: Compliance with 42 CFR 435, which mandates proper documentation and electronic verification 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

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: 2024-009 Inadequate Request for Information 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. 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 24 errors discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. Of these 24 errors, two were determined to be an eligibility error with potential questioned costs. As a result of the lack of a proper eligibility determination, federal funds were distributed to ineligible recipients. Due to the nature of these types of eligibility determinations and the lack of a proper review by the department, the auditor is unable to determine the known or likely 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, 2023-010. 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) 119

Corrective Action Plan

Corrective Action Plan For the Year Ended June 30, 2024 Finding 2024-009 Inadequate Request for Information Name of contact person: Corrective Action: Proposed completion date: Section III - Federal Award Findings and Question Costs (continued) Develop and implement standardized request forms or templates to ensure all required information is consistently requested. Requests should explicitly list the documents or details needed, including examples (e.g., “bank statements for the last 3 months,” “proof of income,” or “vehicle registration”). Conduct targeted training sessions focused on requesting information accurately and comprehensively, including case scenarios and examples of complete and incomplete requests. Ensure staff are familiar with the guidelines on what information is required based on program eligibility rules. Reinforce these guidelines in regular meetings. Require staff to use an Eligibility Request Checklist before sending information requests to ensure all necessary items are included and accurately described. Incorporate checklists into second-party reviews to catch errors or omissions before client communication is sent. Supervisors should review outgoing requests during second-party or random audits to ensure they meet the standards of completeness and clarity. Use case management systems to track and audit requests for adequacy and timeliness. Access the Inbox/Task Dashboard in NC FAST to review pending tasks and notifications. Focus on tasks related to requests for information to ensure timely follow-up. Set reminders for staff to address tasks nearing their deadlines. Use the Verification Report in NC FAST to identify cases where requested information is still missing. This report helps staff track what verifications are outstanding. Run O&M reports to monitor applications, recertifications, and requests for information that are incomplete or overdue. Use these reports to identify cases where staff may have issued inadequate or untimely requests. Filter reports by due dates to ensure that cases are progressing within program timeframes (e.g., 45-day processing deadlines). Access the Evidence Dashboard in NC FAST to confirm whether evidence entries match the requested documents. Check if all evidence has been appropriately documented, verified, and updated within the system. Ensure that staff are documenting details of all requests for information in the case notes, including: What was requested. When it was requested. How it was communicated (e.g., mail, phone, email). Case notes should also reflect follow-up actions. Create a Compliance Log: Maintain a log of cases flagged for inadequate or late requests for information. Use this log to track resolution and identify recurring staff training needs. Management monitor daily to track progress of this issue and modify the controls as needed. 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 126

Categories

Eligibility

Other Findings in this Audit

  • 529239 2024-006
    Significant Deficiency Repeat
  • 529240 2024-007
    Significant Deficiency Repeat
  • 529241 2024-008
    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