FAC Explorer

Finding 946766 (2022-007)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2022
Accepted
2024-02-23
Audit: 291952
Organization: Anson County (NC)
Auditor: Thompson Price Scott Adams & CO

AI Summary

  • Core Issue: There is a significant deficiency in the eligibility determination process for Medicaid, leading to potential approvals for ineligible benefits.
  • Impacted Requirements: Compliance with Medicaid Manual MA-3365 regarding case evaluations and referrals to Child Support Enforcement Agencies is not being met.
  • Recommended Follow-Up: Implement internal reviews of case files to ensure accurate documentation and adherence to eligibility procedures.

Finding Text

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2022-007 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: The County agrees with the finding. See corrective action plan. Program Names: Medical Assistance AL # 93.778 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. Section III - Federal Award Findings and Questioned Costs (continued) We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine 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 North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. IV-D Non-Cooperation Views of Responsible Officials and Planned Corrective Actions: 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 Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. There were 3 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-008.

Categories

Eligibility Significant Deficiency

Other Findings in this Audit

  • 370323 2022-006
    Significant Deficiency Repeat
  • 370324 2022-007
    Significant Deficiency Repeat
  • 370325 2022-008
    Significant Deficiency Repeat
  • 370326 2022-009
    Significant Deficiency Repeat
  • 370327 2022-010
    Significant Deficiency
  • 946765 2022-006
    Significant Deficiency Repeat
  • 946767 2022-008
    Significant Deficiency Repeat
  • 946768 2022-009
    Significant Deficiency Repeat
  • 946769 2022-010
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.568 Low-Income Home Energy Assistance $1.35M
93.778 Medical Assistance Program $1.05M
93.558 Temporary Assistance for Needy Families $490,137
93.563 Child Support Enforcement $410,156
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $347,306
20.106 Airport Improvement Program $324,197
93.268 Immunization Cooperative Agreements $284,995
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $162,918
93.667 Social Services Block Grant $152,248
20.509 Formula Grants for Rural Areas and Tribal Transit Program $130,759
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $82,785
97.042 Emergency Management Performance Grants $63,047
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $57,716
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $55,540
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $50,795
16.738 Edward Byrne Memorial Justice Assistance Grant Program $36,898
93.991 Preventive Health and Health Services Block Grant $35,565
93.052 National Family Caregiver Support, Title Iii, Part E $31,680
93.069 Public Health Emergency Preparedness $30,387
93.217 Family Planning_services $26,613
93.767 Children's Health Insurance Program $14,064
93.053 Nutrition Services Incentive Program $13,615
93.994 Maternal and Child Health Services Block Grant to the States $12,037
93.659 Adoption Assistance $10,176
93.645 Stephanie Tubbs Jones Child Welfare Services Program $2,174
93.043 Special Programs for the Aging_title Iii, Part D_disease Prevention and Health Promotion Services $1,700
12.401 National Guard Military Operations and Maintenance (o&m) Projects $958
93.556 Promoting Safe and Stable Families $458
93.977 Preventive Health Services_sexually Transmitted Diseases Control Grants $100
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $21
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $16
93.658 Foster Care_title IV-E $-193,220