FAC Explorer

Finding 611018 (2022-006)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2022
Accepted
2023-03-30
Audit: 32534
Organization: Onslow County, North Carolina (NC)
Auditor: Martin Starnes & Associates CPAS P A

AI Summary

  • Core Issue: There was a discrepancy in income documentation for one Medicaid case, but the participant remained eligible after review.
  • Impacted Requirements: Compliance with 42 CFR 435 and 2 CFR 200 regarding eligibility documentation and internal controls was not fully met.
  • Recommended Follow-Up: Caseworkers need to ensure all eligibility documentation is complete and accurate during determinations.

Finding Text

Finding: 2022-006 U.S. Department of Health and Human Services Passed through the N.C. Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL #: 93.778 Internal Control, Significant Deficiency Criteria: In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific eligibility standards, and documentation must be maintained to support those determinations. In accordance with 2 CFR 200, management should have an adequate system of internal control procedures in place to ensure the accuracy of benefits being provided is within program requirements. Management must monitor activities under federal awards to assure compliance with federal requirements. Condition: One casefile had income documented in NC FAST that did not match supporting source document (AVS). After review of the cases, the participant was found to still be eligible for Medicaid benefits. Context: Of the 1,159,466 benefit payment cases valued at $357,644,529, we examined 60 payment records ($11,247 value) and determined that the above condition to one payment (.15% valued at $17). We determined that the participant was still eligible after redetermination with the correct documentation. Effect: Participants could receive benefits for which they are not eligible. Cause: Caseworkers did not take proper steps in making sure what was used for eligibility determination was complete and accurate per program guidelines. Questioned Costs: The finding represents an internal control weakness; therefore, no questioned costs are applicable. Upon further review, the applicant was still eligible to receive Medicaid benefits. Recommendation: Caseworkers should review their eligibility determinations and ensure all documentation is included and accurate. Views of Responsible Officials and Planned Corrective Action: See Corrective Action Plan submitted with this report.

Categories

Eligibility Significant Deficiency Internal Control / Segregation of Duties

Other Findings in this Audit

  • 34572 2022-007
    Significant Deficiency
  • 34573 2022-007
    Significant Deficiency
  • 34574 2022-005
    Significant Deficiency
  • 34575 2022-005
    Significant Deficiency
  • 34576 2022-006
    Significant Deficiency Repeat
  • 611014 2022-007
    Significant Deficiency
  • 611015 2022-007
    Significant Deficiency
  • 611016 2022-005
    Significant Deficiency
  • 611017 2022-005
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
20.106 Airport Improvement Program $4.67M
21.027 Coronavirus State and Local Fiscal Recovery Funds $4.06M
93.778 Medical Assistance Program $3.80M
93.568 Low-Income Home Energy Assistance $2.06M
93.558 Temporary Assistance for Needy Families $1.32M
93.563 Child Support Enforcement $628,890
93.667 Social Services Block Grant $607,491
93.658 Foster Care_title IV-E $557,306
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $361,432
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $345,634
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $285,849
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $282,322
21.019 Coronavirus Relief Fund $247,379
16.745 Criminal and Juvenile Justice and Mental Health Collaboration Program $197,101
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $178,393
16.001 Law Enforcement Assistance_narcotics and Dangerous Drugs_laboratory Analysis $146,567
20.616 National Priority Safety Programs $120,342
97.042 Emergency Management Performance Grants $119,852
93.268 Immunization Cooperative Agreements $115,757
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $115,046
93.217 Family Planning_services $90,314
93.645 Stephanie Tubbs Jones Child Welfare Services Program $84,163
16.922 Equitable Sharing Program $78,315
93.659 Adoption Assistance $76,172
93.767 Children's Health Insurance Program $73,056
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $69,186
93.069 Public Health Emergency Preparedness $61,085
93.556 Promoting Safe and Stable Families $42,155
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $39,900
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $37,729
93.421 Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nations Health $36,493
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $23,125
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $22,981
16.738 Edward Byrne Memorial Justice Assistance Grant Program $22,350
45.310 Grants to States $18,641
93.994 Maternal and Child Health Services Block Grant to the States $16,009
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $12,191
93.071 Medicare Enrollment Assistance Program $9,978
93.991 Preventive Health and Health Services Block Grant $9,745
97.067 Homeland Security Grant Program $9,494
93.324 State Health Insurance Assistance Program $7,513
93.052 National Family Caregiver Support, Title Iii, Part E $7,224
93.043 Special Programs for the Aging_title Iii, Part D_disease Prevention and Health Promotion Services $3,223
93.977 Preventive Health Services_sexually Transmitted Diseases Control Grants $2,542
16.835 Body Worn Camera Policy and Implementation $2,362
93.566 Refugee and Entrant Assistance_state Administered Programs $1,035