FAC Explorer

Finding 586352 (2023-004)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2024-01-25
Audit: 13548
Organization: Edgecombe County (NC)
Auditor: Thompson Price Scott Adams & CO P A

AI Summary

  • Core Issue: Significant deficiencies in eligibility processes for the Medical Assistance Program (Medicaid) were identified, including non-cooperation with Child Support Enforcement and inaccurate information entry.
  • Impacted Requirements: Compliance with Medicaid Manual MA-3365 is critical; all cases must be evaluated for referrals to Child Support Agencies, and proper documentation is essential for eligibility determinations.
  • Recommended Follow-Up: Conduct internal reviews of files to ensure accurate information and adherence to procedures; improve case review processes to prevent repeat findings.

Finding Text

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: 2023-004 IV-D Non-Cooperation SIGNIFICANT DEFICIENCY ELIGIBILITY 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: 2023-005 Inaccurate Information Entry SIGNIFICANT DEFICIENCY ELIGIBILITY Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken when determine eligibility. The results found or documentation made in case notes should clearly indicate what actions were performed and the results of those actions. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-003. Effect: 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. Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Section III. Federal Award Findings Criteria: In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Department of Social Services (DSS) and Child Support Agencies must be met or good cause for not cooperating must be established when determine Medicaid eligibility. Condition: There were 4 errors discovered during our procedures that referrals between the County's Department of Social Services and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 from a total of 911,554 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.

Categories

Eligibility Significant Deficiency

Other Findings in this Audit

  • 9910 2023-004
    Significant Deficiency Repeat
  • 9911 2023-005
    Significant Deficiency Repeat
  • 9912 2023-006
    Significant Deficiency Repeat
  • 9913 2023-007
    Significant Deficiency Repeat
  • 9914 2023-008
    Significant Deficiency Repeat
  • 586353 2023-005
    Significant Deficiency Repeat
  • 586354 2023-006
    Significant Deficiency Repeat
  • 586355 2023-007
    Significant Deficiency Repeat
  • 586356 2023-008
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
21.027 Coronavirus State and Local Fiscal Recovery Funds $5.99M
93.778 Medical Assistance Program $1.78M
93.563 Child Support Enforcement $984,140
93.558 Temporary Assistance for Needy Families $944,426
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $732,296
93.568 Low-Income Home Energy Assistance $634,693
10.760 Water and Waste Disposal Systems for Rural Communities $503,000
93.658 Foster Care_title IV-E $465,309
93.667 Social Services Block Grant $415,990
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $233,159
93.994 Maternal and Child Health Services Block Grant to the States $203,961
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $164,484
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $142,342
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $119,410
20.600 State and Community Highway Safety $72,727
93.268 Immunization Cooperative Agreements $71,746
93.217 Family Planning_services $55,168
93.659 Adoption Assistance $41,632
97.042 Emergency Management Performance Grants $39,032
93.767 Children's Health Insurance Program $34,381
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $32,961
93.069 Public Health Emergency Preparedness $31,126
93.991 Preventive Health and Health Services Block Grant $30,651
93.053 Nutrition Services Incentive Program $28,576
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $24,544
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $21,061
16.001 Law Enforcement Assistance_narcotics and Dangerous Drugs_laboratory Analysis $13,500
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $9,896
93.645 Stephanie Tubbs Jones Child Welfare Services Program $6,630
93.556 Promoting Safe and Stable Families $2,333
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $1,925