Bertie CountyLocal Government

Information on the federal program: Medicaid Cluster (Medicaid), Assistance Listing Number 93.778, U.S. Department of Health and Human Services, passed through the N.C. Department of Health and Human Services (NCDHHS), Division of Social Services Criteria: Per the NCDHHS policy manual, salaries, wages, and fringe benefits of Department of Social Service employees hired under the state merit system are allowable. Salaries shall be allocated to programs by time distribution methods and supported by payroll and attendance records for individuals. Condition: Employee’s time is tracked through the use of day sheets in which employees track their time by service code in 6-minute increments. Day sheets are used to complete weekly timesheets which are approved by supervisors. We noted two out of twenty-three daysheets selected for Medicaid had more program minutes than what was reported on the employee’s approved time sheet. Context/Cause: The day sheets included more program time than was included on the employee’s approved timesheet. We noted the above condition in two out of twenty-three day sheets selected for Medicaid. Effects: Inaccurate reporting of time coded to programs could affect the total federal and state reimbursement for the program. Recommendation: We recommend that the County implements a review control over weekly timesheets to ensure the timesheets include all program time coded on the daysheets. Auditee’s Response: We concur with the finding.

Information on the federal program: COVID-19 – Coronavirus State and Local Fiscal Recovery Funds (SLFRF), Assistance Listing Number 21.027, U.S. Department of the Treasury Criteria: The 2 CFR § 200.303 requires that non-Federal entities establish and maintain effective internal control over the Federal award that provides reasonable assurance that the entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Additionally, the SLFRF Compliance and Reporting Guidance requires recipients to maintain records and financial documents for a period of five years after all funds have been expended or returned to Treasury, which includes documentation of the reports submitted. Condition: During our testing of the quarterly Project and Expenditure (P&E) reports submitted to the U.S. Department of the Treasury, the County was unable to provide documentation or audit logs from the Treasury Portal demonstrating the internal review and approval process. Specifically, the County could not provide evidence of: • The identity of the individual who prepared the report. • The identity of the supervisor/official who reviewed and authorized the submission. • The specific date and time the reports were submitted. Due to significant staff turnover, the login credentials and historical "submission confirmation" records were not maintained or accessible for the audit period. Context/Cause: The County experienced turnover in key administrative positions responsible for ARPA grant management. The departing staff did not transition portal access or download the "Submission Summary" reports prior to their departure, and the County did not have a secondary process to archive these records outside of the portal. Effects: Without evidence of a formal review and approval process, there is an increased risk that inaccurate or unauthorized financial data could be reported to the Federal government. This lack of documentation constitutes a significant deficiency in internal controls over the reporting compliance requirement. Recommendation: The County should strengthen its internal controls over Federal reporting by archiving submissions, utilizing formal approval logs, and implementing succession planning. Auditee’s Response: We concur with the finding

Significant Deficiency over Activities Allowed and Unallowed and Allowable Costs/Cost Principles; Information on the federal programs: Medicaid Cluster (Medicaid), Assistance Listing Number 93.778, U.S. Department of Health and Human Services, passed through the N.C. Department of Health and Human Services (NCDHHS), Division of Social Services Criteria: Per the NCDHHS policy manual, salaries, wages, and fringe benefits of Department of Social Service employees hired under the state merit system are allowable. Salaries shall be allocated to programs by time distribution methods and supported by payroll and attendance records for individuals. Condition: Employee’s time is tracked through the use of day sheets in which employees track their time by service code in 6-minute increments. Day sheets are used to complete weekly timesheets which are approved by supervisors. We noted two out of twenty-three daysheets selected for Medicaid had more program minutes than what was reported on the employee’s approved time sheet. Context/Cause: The day sheets included more program time than was included on the employee’s approved timesheet. We noted the above condition in two out of twenty-three day sheets selected for Medicaid. Effects: Inaccurate reporting of time coded to programs could affect the total federal and state reimbursement for the program. Recommendation: We recommend that the County implements a review control over weekly timesheets to ensure the timesheets include all program time coded on the daysheets. Auditee’s Response: We concur with the finding.

Significant Deficiency over Eligibility; Information on the federal programs: Medicaid Cluster (Medicaid), Assistance Listing Number 93.778, U.S. Department of Health and Human Services, passed through the N.C. Department of Health and Human Services (NCDHHS), Division of Social Services (DSS). Criteria: Per the Medicaid and NCHC Eligibility Review Document, the County DSS should send the DMA-5097, Request for Information, to the non-custodial parent after application approval. The beneficiary is allowed 12 calendar days to provide information. The casefile must contain information on the non-custodial parent. If no information is provided on the non-custodial parent, case should terminate by date shown on timely notice. Condition: Each casefile should contain information on the non-custodial parent, requested by the County DSS after the approval of the application. We noted one casefile that did not have information for one of the children. Context/Cause: No child support referral was conducted. We noted the above condition in one of the sixty Medicaid cases selected. Effects: Lack of required support due to County DSS not conducting a timely child support referral could affect the total federal and state reimbursement for the program, as the benefits should have been terminated. Recommendation: We recommend that the County implements a review control over eligibility requirements. Auditee’s Response: We concur with the finding.

Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application/recertification and these items will agree to reports in the NC FAST system. In this process, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered in regards to a specific eligibility requirement and explained within the documentation. Condition: There were thirty-three (33) 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. The errors were as follows: Four (4) cases did not have accurate resource calculations, Eight (8) cases did not have accurate budget calculations, Sixteen (16) cases had a failure to complete at least one compliance component, Four (4) case contained an inaccurate needs unit calculation. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context: We examined 91 of the 279,124 Medicaid case files to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource or program specific requirements and a participant could have been approved for benefits that they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-001. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.

Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application/recertification and these items will agree to reports in the NC FAST system. In this process, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered in regards to a specific eligibility requirement and explained within the documentation. Condition: There were fifty-seven (57) 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. The errors were as follows: Thirteen (13) cases did not have accurate resource calculations, Nineteen (19) cases did not have accurate budget calculations, Twentythree (23) cases had a failure to complete at least one compliance component, One (1) case lacked sufficient documentation errors, One (1) case contained an inaccurate needs unit calculation. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context: We examined 120 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource or program specific requirements and a participant could have been approved for benefits that they were not eligible. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2020-001.

Criteria: 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. Condition: There was one error discovered during our procedures that SSI ex parte review procedures were not followed causing benefits to continue while eligibility remained unchecked. An applicant/beneficiaries received assistance for which the recipient was not eligible. Questioned Costs: The amount of claims paid on behalf of the above ineligible participants for fiscal year ending 6/30/2021 did not exceed the threshold for a questioned cost determination. Context: We examined 120 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource or program specific requirements and a participant could have been approved for benefits that they were not eligible. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participate in the review process. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2020-002.

Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that verifications were done in preparation of the application/recertification and these items will agree to reports in the NC FAST system. In this process, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered in regards to a specific eligibility requirement and explained within the documentation. Condition: There were forty-four (44) technical errors discovered during our procedures that verifications in the county documentation and the representative data contained in NC FAST were not the same amounts or files containing policy requirements were not properly documented to be considered in compliance with program control requirements. The errors were as follows: Six (6) did not have child support referrals completed, Nine (9) contained incomplete or untimely verification of facts, Thirteen (13) did not have accurate budget calculations in NC FAST, Three (3) lacked sufficient required documentation, Nine (9) did not have accurate resource calculations, Four (4) contained inaccurate needs unit calculations. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context: We examined 120 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource or program specific requirements and a participant could have been approved for benefits that they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2019-001. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.

Criteria: 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. Condition: There were two errors discovered during our procedures that inaccurate information was entered when determining eligibility. Two applicant/beneficiaries that received assistance for which the recipient was not eligible Questioned Costs: The amount of claims paid on behalf of the above ineligible participants for fiscal year ending 6/30/2020 did not exceed the threshold for a questioned cost determination. Context: We examined 120 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource or program specific requirements and a participant could have been approved for benefits that they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2019-002. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participate in the review process.

SIGNIFICANT DEFICIENCY US Department of Agriculture Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2019 ? 001 Eligibility Criteria: 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. Condition: There were forty one (41) 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. The errors were as follows: Eight (8) did not have child support referrals completed, Eleven (11) did not have accurate budget calculations in NC FAST, Thirteen (13) lacked sufficient required documentation, Six (6) contained a budget error, Three (3) contained a clerical errors in data entry. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context: We examined 60 Medicaid applicants to re-determine eligibility. These findings were disclosed in a separately issued report to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource and a participant could have been approved for benefits that they were not eligible. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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 that clearly indicates what actions were performed and the results of those actions. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.

US Department of Agriculture Passed through the NC Dept. of Health and Human Services Program Name: Medical Assistance Program (Medicaid; Title XIX) CFDA # 93.778 Finding: 2019 ? 002 MATERIAL WEAKNESS MATERIAL NONCOMPLIANCE ELIGIBILITY Criteria: Medicaid for Aged, Blind and Disabled case records should contain documentation that tax records and Register of Deeds were checked to verify if the individual owns property. The files should also contain documentation on any property found as to whether it is a countable resource or is exempt from the resources calculation. Condition: There was one error in each of three files dealing with the following: ? Two were found to have benefits to be paid outside of certification period. ? One case contained a budget calculation error which resulted in the client receiving a benefit of which they were not eligible. Questioned Costs: There were questioned costs of $2,121 on these cases. This amount was determined by totaling all the aid received by the applicants who were not eligible. Context: Of the 3,424 case files, we examined 60 applicants and determined that three applicants received assistance for which eligibility was not properly determined. Effect: For that certification/recertification there was a chance that property was owned that would not have been treated as a countable resource and a person could have been approved for benefits that they were not eligible. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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 a print out as evidence that the Register of Deeds was checked and the results found or documentation made in case notes that clearly indicates what actions were performed and the results of those actions. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.