Finding 947634 (2023-005)

Significant Deficiency Repeat Finding
Requirement
E
Questioned Costs
-
Year
2023
Accepted
2024-02-29

AI Summary

  • Core Issue: Repeat findings of inaccurate information entry and untimely reviews affecting Medicaid eligibility determinations.
  • Impacted Requirements: Non-compliance with 42 CFR 435 and 2 CFR 200 regarding documentation and internal controls for eligibility.
  • Recommended Follow-up: Conduct internal reviews, retrain staff on documentation standards, and ensure all files include necessary verifications and clear case notes.

Finding Text

Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: US 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: 2023-005 Inaccurate Information Entry SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Cost: There was no known affect to eligibility and there were no known questioned costs. 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. In accordance with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an applicant is properly determined or redetermined for benefits. There were 3 errors discovered during our procedures that inaccurate information was entered when determining eligibility. The County agrees with the finding. 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. Section III - Federal Award Findings and Questioned Costs (Continued) Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. We examined 60 cases from of a total of 552,116 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 NC FAST and applicants could have been approved for benefits for which they were not eligible. This is a repeat finding from the immediate previous audit, 2022-006. Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: US 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: 2023-006 Untimely Review of SSI Termination SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Cost: Section III - Federal Award Findings and Questioned Costs (Continued) There was 1 applicant/beneficiary was not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated. There was no known affect to eligibility and there were no known questioned costs. The County agrees with the finding. This is a repeat finding from the immediate previous audit, 2022-007. In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid. We examined 60 cases from of a total of 552,116 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 NC FAST and a participant could have been approved for benefits for which they were not eligible. 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 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.

Categories

Eligibility Reporting Internal Control / Segregation of Duties

Other Findings in this Audit

  • 371189 2023-002
    Significant Deficiency Repeat
  • 371190 2023-003
    Significant Deficiency Repeat
  • 371191 2023-004
    Significant Deficiency Repeat
  • 371192 2023-005
    Significant Deficiency Repeat
  • 371193 2023-006
    Significant Deficiency Repeat
  • 371194 2023-007
    Significant Deficiency
  • 947631 2023-002
    Significant Deficiency Repeat
  • 947632 2023-003
    Significant Deficiency Repeat
  • 947633 2023-004
    Significant Deficiency Repeat
  • 947635 2023-006
    Significant Deficiency Repeat
  • 947636 2023-007
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
21.027 Coronavirus State and Local Fiscal Recovery Funds $9.45M
93.778 Medical Assistance Program $1.77M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $832,406
93.563 Child Support Enforcement $686,038
93.568 Low-Income Home Energy Assistance $392,750
93.558 Temporary Assistance for Needy Families $367,472
93.667 Social Services Block Grant $323,370
21.016 Equitable Sharing $258,905
16.922 Equitable Sharing Program $216,506
93.658 Foster Care_title IV-E $189,208
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $159,472
93.659 Adoption Assistance $137,187
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $99,420
20.513 Enhanced Mobility of Seniors and Individuals with Disabilities $93,492
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $85,220
93.767 Children's Health Insurance Program $56,274
97.042 Emergency Management Performance Grants $39,032
93.053 Nutrition Services Incentive Program $30,039
45.310 Grants to States $16,309
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $14,842
93.645 Stephanie Tubbs Jones Child Welfare Services Program $11,369
93.556 Promoting Safe and Stable Families $9,585
93.052 National Family Caregiver Support, Title Iii, Part E $3,903
21.032 Local Assistance $819