FAC Explorer

Finding 573742 (2023-015)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2025-08-18
Audit: 364406
Organization: Caswell County (NC)
Auditor: Thompson Price Scott Adams & CO

AI Summary

  • Core Issue: Inadequate documentation and record-keeping led to errors in eligibility determinations for Medicaid claims.
  • Impacted Requirements: Compliance with 42 CFR 435, which mandates proper documentation for eligibility assessments.
  • Recommended Follow-Up: Implement corrective actions as outlined in the county's plan to improve documentation and case review processes.

Finding Text

CASWELL COUNTY, NORTH CAROLINA Schedule of Findings and Questioned Costs For the Year Ended June 30, 2023 Views of Responsible officials and corrective action plans: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medicaid Assistance Program (Medicaid; Title XIX) AL# 93.778 Finding: 2023-015 Inadequate Request for Information SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat Cause: We examined 60 cases from of a total of 229,178 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. There was no known affect to eligibility and there were no known questioned costs. Section III. Federal Award Findings and Questioned Costs (continued) For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. 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 11 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. The county agrees with the finding. Please refer to the corrective action plan for details. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. This is a repeat finding from the immediate previous audit, 2022-014 128

Corrective Action Plan

CASWELL COUNTY 144 Court Square, Yanceyville, NC 27379 www.caswellcountync.gov 336/694-4193 Corrective Action Plan For the Year Ended June 30, 2023 Finding: 2023-015 Inadequate Request for Information Name of contact person: Corrective Action: Proposed Completion Date: Heather Starr Thomas, Medicaid Supervisor Section III - Federal Award Findings and Question Costs (continued) April 11, 2024 Cases will be reviewed internally to ensure proper documentation is in place for eligibility. Workers will be retrained on what cases should contain and the importance of complete and accurate record keeping. All cases will include online verifications ran timely, documented resources, income and make certain those amounts agree to information input into NC FAST. The results found or documentation made in case notes should clearly indicate what actions were performed by the caseworker and the results of those actions. Information must be updated at every application/recertification and change in circumstance adhering to Medicaid Policy. Templates have been updated to address request for information, income verifications, reasonable compatibility and to include electronic resources are ran with verification of date ran. CW must address all Household income and have clear documentation of request or findings. Training targeted to address error trend of Documentation of Vehicles and Rebuttals. Training targeted to address error trend of evaluation of 1/3 reduction. Information requested from OST to properly enter 1/3 reduction in NCFAST obtained. Training targeted for applicable staff to address Transfer of Asset requirements and how to address and clearly document transfers. Help Desk tickets should be submitted timely if information or functionality is not working properly. All avenues available to caseworker must be exhausted before requesting information from client, unless information provided and information obtained is questionable. We will continue to train on this issue, and it will also be addressed in new worker Trainings. Training in the learning gateway is also available. 140

Categories

Eligibility Significant Deficiency

Other Findings in this Audit

  • 573740 2023-013
    Significant Deficiency Repeat
  • 573741 2023-014
    Significant Deficiency Repeat
  • 573743 2023-016
    Significant Deficiency
  • 1150182 2023-013
    Significant Deficiency Repeat
  • 1150183 2023-014
    Significant Deficiency Repeat
  • 1150184 2023-015
    Significant Deficiency Repeat
  • 1150185 2023-016
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
21.027 Coronavirus State and Local Fiscal Recovery Funds $2.79M
14.871 Section 8 Housing Choice Vouchers $1.03M
93.778 Medical Assistance Program $659,101
93.563 Child Support Services $353,946
93.558 Temporary Assistance for Needy Families $328,539
20.509 Formula Grants for Rural Areas and Tribal Transit Program $301,469
93.667 Social Services Block Grant $242,663
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $205,790
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $196,571
93.568 Low-Income Home Energy Assistance $144,081
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $120,994
93.658 Foster Care Title IV-E $110,025
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $93,374
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $75,616
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $70,021
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $67,980
93.268 Immunization Cooperative Agreements $62,746
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $41,496
97.042 Emergency Management Performance Grants $39,032
93.217 Family Planning Services $32,941
93.053 Nutrition Services Incentive Program $25,820
45.310 Grants to States $24,787
93.994 Maternal and Child Health Services Block Grant to the States $22,637
93.991 Preventive Health and Health Services Block Grant $22,574
20.513 Enhanced Mobility of Seniors and Individuals with Disabilities $17,997
93.767 Children's Health Insurance Program $13,111
93.069 Public Health Emergency Preparedness $10,974
93.659 Adoption Assistance $7,174
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $2,638
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $1,844
93.645 Stephanie Tubbs Jones Child Welfare Services Program $1,671
93.556 Marylee Allen Promoting Safe and Stable Families Program $1,500
93.000 Foster Care $344
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $100