FAC Explorer

Finding 8195 (2023-003)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2024-01-10
Audit: 10750
Organization: Washington County (NC)
Auditor: Thompson Price Scott Adams & CO P A

AI Summary

  • Core Issue: Inadequate documentation and information requests during Medicaid eligibility determinations, leading to a repeat finding from the previous audit.
  • Impacted Requirements: Compliance with 42 CFR 435, which mandates proper documentation and electronic matches for eligibility assessments.
  • Recommended Follow-Up: Conduct internal file reviews, retrain staff on documentation standards, and ensure all files include necessary verifications and reconciliations with NC FAST.

Finding Text

Passed through the NC Department of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) AL#: 93.778 Finding: 2023-003 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: The County agrees with the finding. This is a repeat finding from the immediate previous audit, 2022-004. 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. Section III. Federal Award Findings and Questioned Costs (continued) There were 6 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. There was no known affect to eligibility and there were no known questioned costs. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. 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 and 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. We examined 60 cases from of a total of 175,350 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 applicants could have been approved for benefits for which they were not eligible.

Corrective Action Plan

Finding: 2023-003 Name of Contact Person: Tammy Mixon, Medicaid Supervisor Corrective Action: Proposed Completion Date: Section III. Federal Award Findings and Questioned Costs Missy Dixon, Finance Officer COUNTY OF WASHINGTON BOARD OF COMMISSIONERS The County Finance Office had already identified this issue and had added the costs to our Fixed Asset List indicating that these expenses were prior period. Both the Finance Officer and the Deputy Finance Officer have always and will continue to add and review purchases and projects throughout the fiscal year and at year end with our Contracted CPA. Immediately For the Year Ended June 30, 2023 POST OFFICE BOX 1007 Corrective Action Plan PLYMOUTH, NORTH CAROLINA 27962 OFFICE (252) 793-5823 FAX (252) 793-1183 Section II. Financial Statement Findings This was discussed with our OST Rep. and received clarification of policy on 09/15/2023 by conference call and now Adult workers are following clarification by policy to claim 100% of account, unless written statements change approval criteria. Staff was advised by phone conference with the Operation Support Team staff member Paula Taylor on 9/15/2023 regarding policy clarification on joint bank accounts (other than spouse), and follow up email was received from Ms. Taylor same date and forwarded to staff from Supervisor. Caseworkers have been reminded and trained by state Webinar that the Work Number (TWN) must not be run outside of NC Fast. There is no exception for running TWN unless advised otherwise by state personnel. Caseworkers must reach out to Supervisor for a ticket to be authorized by the state prior to running TWN outside of NC Fast. This case was completed before the 8/24/2021 training about TWN. TWN training was on 10/12/2023 and 2 Fact Sheets were forwarded to the caseworkers the same day which was provided on 10/12/2023 to go with the training. Medicaid workers also heard about TWN being required in NCFAST (page 47) in March 2023 (3/8/, 3/14, 3/16, 3/21) training provided to Medicaid Workers titled 2023 Recertification Refresher Training and the PDF of that training was provided on 5/22/2023 to staff and forwarded same day to caseworkers. Also the Q & A sent to workers on 4/4/2023 and updated to include the TWN guidance on 4/25/2023 attached TWN questions from the March 2023 was forwarded to caseworkers the same day.

Categories

Eligibility

Other Findings in this Audit

  • 8194 2023-002
    Significant Deficiency Repeat
  • 584636 2023-002
    Significant Deficiency Repeat
  • 584637 2023-003
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $579,031
21.027 Coronavirus State and Local Fiscal Recovery Funds $550,097
93.558 Temporary Assistance for Needy Families $366,969
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $339,952
93.568 Low-Income Home Energy Assistance $204,286
20.106 Airport Improvement Program $181,197
93.563 Child Support Enforcement $173,137
93.667 Social Services Block Grant $147,899
93.658 Foster Care_title IV-E $137,026
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $81,723
20.509 Formula Grants for Rural Areas and Tribal Transit Program $74,961
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $73,813
21.032 Local Assistance $72,294
97.042 Emergency Management Performance Grants $50,100
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $17,044
93.767 Children's Health Insurance Program $15,373
93.000 Foster Care $11,134
93.556 Promoting Safe and Stable Families $9,288
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $7,178
97.053 Citizens-Community Resilience Innovation Challenge $6,675
93.071 Medicare Enrollment Assistance Program $2,500
20.526 Buses and Bus Facilities Formula, Competitive, and Low Or No Emissions Programs $1,967
93.645 Stephanie Tubbs Jones Child Welfare Services Program $182