FAC Explorer

Finding 7070 (2023-003)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2024-01-02
Audit: 9079
Organization: Nash County (NC)
Auditor: Thompson Price Scott Adams & CO P A

AI Summary

  • Core Issue: There were discrepancies in resource entries for Medicaid eligibility, leading to potential inaccuracies in benefit approvals.
  • Impacted Requirements: Documentation must align with Medicaid Manual MA-2230, ensuring countable resources are accurately recorded and verified against the NC FAST system.
  • Recommended Follow-Up: Conduct internal reviews of files, retrain staff on documentation standards, and ensure all records include necessary verifications and clear case notes.

Finding Text

U.S. 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: 2023-003 Inaccurate Resources Entry SIGNIFICANT DEFICENCY Eligibility Criteria: In accordance with Medicaid Manual MA-2230, 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 were 3 errors discovered during our procedures that resources in the county documentation and those same resources contained in NC FAST were not the same amounts or files containing resources were not properly documented to be considered countable or non-countable. We examined 60 of a total of 1,030,518 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. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and a participant could have been approved for benefits for which they were not eligible. This is a repeat finding from the immediate previous audit, 2022-003. 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.

Corrective Action Plan

Finding 2023-003 Name of contact person: Corrective Action: Proposed completion date: Section II - Financial Statement Findings Section III - Federal Award Findings and Questioned Costs For the Year Ended June 30, 2023 Corrective Action Plan Immediately and ongoing Donna Wood, Finance Director Training will occur Nov. 30th 2023. Team meeting will be held to discuss findings of audit, errors cited to include Household Composition, income calculation and TWN calls for each household member age 14 or old on an application or Recertification. Finance Director will review year end salary accrual along with the Payroll Specialist to ensure correct salary accruals. The Finance Director will work with the Accountant to calculate and update the EMS net receivables each year to ensure proper posting to the General Ledger, working with information from the County’s billing and collection agency. Melissa McDaniels –Family and Children's Medicaid Supervisor Training to be provided to all caseworkers to include TWN and OVS learning gateway webinars. Review of policy for exparte process and system reviews. Training to also include Income Policy, how to review for self-employment income and utilize the income wizard to enter weekly, bi-weekly and monthly income amounts so the system will calculate the income and leave less room for user error. Documentation of what income is being evaluated to also include why certain incomes are not counted. Training to include review of Household Composition, tax filing status and how to review the determinations of each case before completing/ releasing auto holds. Lyn Saunders - Adult Medicaid Supervisor Training to be provided to caseworkers to include review of Job Aids for Adding Evidence to an application, Adding Evidence to a Case, and Adding Verifications. Review of MA Policy Financial Resources. Bi-weekly 3-hour staffing sessions with caseworkers. Target 2nd parties will be completed at 2 per worker per week of cases processed within the month. Feedback shared with worker to ensure training was effective. Training will occur December 2023, once the training is provided the additional 2nd parties of cases will begin and continue for 2 months into Feb 2024.

Categories

Eligibility

Other Findings in this Audit

  • 7068 2023-006
    Significant Deficiency
  • 7069 2023-002
    Significant Deficiency Repeat
  • 7071 2023-004
    Significant Deficiency Repeat
  • 7072 2023-005
    Significant Deficiency Repeat
  • 583510 2023-006
    Significant Deficiency
  • 583511 2023-002
    Significant Deficiency Repeat
  • 583512 2023-003
    Significant Deficiency Repeat
  • 583513 2023-004
    Significant Deficiency Repeat
  • 583514 2023-005
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $2.61M
93.563 Child Support Enforcement $1.22M
93.658 Foster Care_title IV-E $622,980
16.922 Equitable Sharing Program $487,153
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $387,999
14.239 Home Investment Partnerships Program $375,037
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $286,276
93.994 Maternal and Child Health Services Block Grant to the States $225,828
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $208,336
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $167,885
20.600 State and Community Highway Safety $145,364
93.568 Low-Income Home Energy Assistance $118,734
21.016 Equitable Sharing $83,990
20.205 Highway Planning and Construction $81,133
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $78,956
21.027 Coronavirus State and Local Fiscal Recovery Funds $77,909
93.000 Foster Care $76,876
93.767 Children's Health Insurance Program $72,836
93.659 Adoption Assistance $65,494
93.217 Family Planning_services $54,905
93.645 Stephanie Tubbs Jones Child Welfare Services Program $39,306
93.069 Public Health Emergency Preparedness $35,457
93.269 Complex Humanitarian Emergency and War-Related Injury Public Health Activities $32,972
93.053 Nutrition Services Incentive Program $31,317
93.991 Preventive Health and Health Services Block Grant $30,607
93.667 Social Services Block Grant $27,375
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $24,103
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $22,420
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $21,420
93.052 National Family Caregiver Support, Title Iii, Part E $20,724
93.556 Promoting Safe and Stable Families $20,076
93.558 Temporary Assistance for Needy Families $17,987
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $8,212
93.268 Immunization Cooperative Agreements $6,407
16.738 Edward Byrne Memorial Justice Assistance Grant Program $612
93.977 Preventive Health Services_sexually Transmitted Diseases Control Grants $100
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $4