EIN: 566000450
UEI: ZTVELM361423
Audited by: CHERRY BEKAERT LLP
Cognizant agency: 21 [Department of the Treasury]
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Data as of September 2, 2026
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on February 10, 2026. Under 2 CFR 200.521(d), a pass-through entity that provided federal funds to this organization for this audit period must issue a management decision on these findings by August 10, 2026 (23 days ago).
What is a management decision? →FAC accepted this audit on February 3, 2026 — management decision was due August 3, 2026.
FAC accepted this audit on December 18, 2024 — management decision was due June 18, 2025.
The County did not follow up with individuals after reviews were completed and issues were noted in the review in accordance with its policies on a consistent basis. The County did not perform a Register of Deeds check during the recertification period. Context: There were 11 instances out of 60 reviews tested in which the County did not remediate the errors identified timely. There was 1 instance out of 60 eligibility samples tested that did not have a Register of Deeds check performed during the recertification period. Questioned Costs: No questioned costs reported. Effect: The caseworkers that had errors identified in their eligibility determinations were not notified timely of the issues which could result in potential future issues. The required procedures and verification checks were not fully followed during the period of recertification. Cause: The County has a policy in place but does not have a way to ensure the policy is being enforced. The County missed the step to run the Register of Deeds check at the time of recertification. Recommendation: We recommend the County assign individuals to ensure all reviews are taking place timely in accordance with its policy including timely follow up with case workers once the review is complete. We also recommend all required steps are performed during eligibility check and the recertification period. Views of Responsible Officials: Management agrees with the finding and is implementing procedures to correct this which is further discussed in the corrective action plan. Corrective Action Plan: See Corrective Action Plan prepared by the County.
Show full finding ▾Hide full finding ▴U.S. Department of Health and Human Services Pass-through Entity: North Carolina Department of Health and Human Services Program Name: Medical Assistance Federal Assistance Listing Number: 93.778 Significant Deficiency and Non-Material Noncompliance – Eligibility Finding 2024-001 Criteria: In accordance with Section 200.303 of the Uniform Guidance, a non-federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. The non-federal entity is also required to confirm that the Register of Deeds was checked for aged, blind, or disabled cases or MQB programs to determine if the individual owns property and is documented in the case file and agrees to information in the NC FAST system. Condition: The County did not follow up with individuals after reviews were completed and issues were noted in the review in accordance with its policies on a consistent basis. The County did not perform a Register of Deeds check during the recertification period. Context: There were 11 instances out of 60 reviews tested in which the County did not remediate the errors identified timely. There was 1 instance out of 60 eligibility samples tested that did not have a Register of Deeds check performed during the recertification period. Questioned Costs: No questioned costs reported. Effect: The caseworkers that had errors identified in their eligibility determinations were not notified timely of the issues which could result in potential future issues. The required procedures and verification checks were not fully followed during the period of recertification. Cause: The County has a policy in place but does not have a way to ensure the policy is being enforced. The County missed the step to run the Register of Deeds check at the time of recertification. Recommendation: We recommend the County assign individuals to ensure all reviews are taking place timely in accordance with its policy including timely follow up with case workers once the review is complete. We also recommend all required steps are performed during eligibility check and the recertification period. Views of Responsible Officials: Management agrees with the finding and is implementing procedures to correct this which is further discussed in the corrective action plan. Corrective Action Plan: See Corrective Action Plan prepared by the County.
Finding 2024-001, Significant Deficiency and Non-Material Non-Compliance - Eligibility: During the Medicaid control testing, eleven cases were identified that required subsequent corrections in NCFAST; however, these corrections were not completed within the 20-day requirement following the case worker’s audit, as mandated by DHHS policy. Corrective Action Plan: Case Corrections Goal: To ensure Medicaid error findings identified by internal and external audits are timely and accurately corrected for compliance, oversight will be provided by Medicaid Leadership and applicable staff. Plan: The county’s Medicaid Audit Submission tool has been revised to include a case correction due date for eligibility, procedural, and internal control findings. The revision ensures compliance with timely and accurate case corrections. Case corrections must be initiated within five business days of the case audit date. When policy allows, case corrections should be completed within 20 days of the case audit. Performance Improvement Strategies: 1. Program managers, supervisors, applicable lead staff, and trainers, will be provided access and training on the audit tool to monitor the compliance of timely and accurate case corrections. 2. Audit reports will be stored on the county’s OneDrive in the Medicaid Division folder. 3. Supervisors will begin to follow up no later than the 6th business day from the date of audit to ensure case corrections have been completed or initiated, at minimum, by the eligibility specialist. Supervisors will follow up throughout the case correction process to ensure corrections are complete and accurate. 4. Each month, for the prior month, each program manager will select a total of ten audit findings from the Medicaid Audit Finding spreadsheet to ensure their assigned supervisors are compliant with the case correction procedure. These compliance reviews will be conducted and saved to the Medicaid Division folder by the last day of the month. Program managers will take further corrective measures if noncompliance is discovered, by first reporting the continued deficiencies to the Medicaid Division Director. Responsible Parties: Medicaid Program Mangers, Jennifer Hurdle and Alison Westbrook Timeframes: A Medicaid Division meeting will be held no later than November 30, 2024, with all program managers, supervisors, lead staff, and trainers to discuss roles and responsibilities, receive the required training, and the state’s requirement of compliance with monthly audits, case corrections, and corrective actions to mitigate risks from recurring. Agenda and sign-in sheet are required and due to D. Hill no later than December 5, 2024. Finding 2024-001, Significant Deficiency and Non-Material Non-Compliance - Eligibility: During the eligibility compliance testing, it was identified that a Register of Deeds (ROD) check had not been performed at the time of recertification for one case. Although this was an oversight, it did not impact the eligibility determination for the case. The ROD results were subsequently reviewed during the audit process, confirming that the beneficiary was appropriately eligible to receive benefits. This error was classified as a procedural and documentation issue related to the completion of the ROD check. Corrective Action Plan: Register of Deeds Goal: To ensure Register of Deeds (ROD) is inquired and the results are uploaded to the County’s document imaging system when policy requires. Plan: Medicaid programs that have a resource limit require inquiries to be made to the local ROD in the applicant's county of residence to assist with identifying countable and non-countable assets such as real property when determining Medicaid eligibility at application and redetermination. Performance Improvement Strategies: 1. Adult Medicaid - program manager, supervisors, applicable lead staff, and trainers, will develop a required documentation template for all Adult Medicaid staff to use when completing applications and recertifications. The template will be used for all programs under the Adult Medicaid umbrella without exception. The template will include a subsection for resources, highlighting the date ROD checks were conducted and uploaded into NC FAST, if applicable. ROD verification of real property and verification of no real property should be uploaded to the attachments folder within the administrative tab on the Income Support Case. 2. The documentation template will be included in the note section on the beneficiary’s person page or the head of household’s (HOH) person page, if the applicant is not the HOH. 3. The required template will be added to the audit tool to ensurecompliance. 4. Supervisors are required to provide compliance when conducting monthly second party reviews by ensuring the required template, documentation, and uploaded ROD verification is present and correct. 5. Supervisors will take further corrective measures if noncompliance is discovered by first reporting the continued deficiencies to the Medicaid Division Director and Adult Medicaid Program Manager. Responsible Parties: Adult Medicaid Program Manager, Supervisors, Lead Staff, and Trainers Timeframes: A Medicaid Division meeting will be held no later than November 30, 2024, with the Adult Medicaid program managers, supervisors, lead staff, trainers, and other applicable staff to introduce and provide training on the mandatory template. The template will be effective December 1, 2024, with supervisor compliance beginning January 1, 2025, for dates of applications beginning December 1, 2024, and redeterminations initiated beginning December 1, 2024. Agenda and sign-in sheet are required and due to D. Hill no later than December 5, 2024.
2023-001
FAC accepted this audit on June 12, 2024 — management decision was due December 12, 2024.
The County did not follow up with individuals after reviews were completed and issues were noted in the review in accordance with its policies on a consistent basis. Context: There were 13 instances out of 60 reviews tested in which the County did not remediate the errors identified timely. Effect: The caseworkers that had errors identified in their eligibility determinations were not notified timely of the issues which could result in potential future issues. Cause: The County has a policy in place but does not have a way to ensure the policy is being enforced. Recommendation: We recommend the County assign individuals to ensure all reviews are taking place timely in accordance with its policy including timely follow up with case workers once the review is complete. Views of Responsible Officials: Management agrees with the finding and is implementing procedures to correct this which is further discussed in the corrective action plan. Corrective Action Plan: See Corrective Action Plan prepared by the County.
Show full finding ▾Hide full finding ▴U.S. Department of Health and Human Services Pass-through Entity: North Carolina Department of Health and Human Services Program Name: Medical Assistance Federal Assistance Listing Number: 93.778 Significant Deficiency - Eligibility Finding 2023-001 Criteria: In accordance with Section 200.303 of the Uniform Guidance, a non-federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition: The County did not follow up with individuals after reviews were completed and issues were noted in the review in accordance with its policies on a consistent basis. Context: There were 13 instances out of 60 reviews tested in which the County did not remediate the errors identified timely. Effect: The caseworkers that had errors identified in their eligibility determinations were not notified timely of the issues which could result in potential future issues. Cause: The County has a policy in place but does not have a way to ensure the policy is being enforced. Recommendation: We recommend the County assign individuals to ensure all reviews are taking place timely in accordance with its policy including timely follow up with case workers once the review is complete. Views of Responsible Officials: Management agrees with the finding and is implementing procedures to correct this which is further discussed in the corrective action plan. Corrective Action Plan: See Corrective Action Plan prepared by the County.
Finding 2023-001, Significant Deficiency - Eligibility Corrective Action Plan: Goal: To ensure necessary Medicaid corrections are made by caseworkers in a timely manner and verified as completed by Medicaid management and/or Quality Assurance staff. Plan: The County will include a due date to the auditing tool so that correction tasks request can be tracked and monitored for completion and accurateness. Eligibility, Internal Control and Procedural Errors will be given 5 business days to be corrected by workers. Performance Improvement Strategies: 1. Training will be given to supervisors, lead workers, and QA staff on proper usage and monitoring of due date requirements added to the audit tool. 2. Copies of reports will be stored in the shared Teams Channel for Medicaid Services. 3. Supervisor will follow up with caseworkers on 6th business days to ensure corrections have been made. 4. Every month, program managers will select 10 examples from the Medicaid Audit Finding spreadsheet to make sure supervisor have handled the error corrections made by their team. Responsible Parties: Medicaid Program Mangers Amanda Burdge, Jennifer Hurdle and Alison Westbrook Timeframes: A Medicaid Division Meeting will be held with all supervisors to discuss the expectation of monthly audits, corrections, and staying in compliance with State requirements. Also, explain the expectations of the Program Managers audit. Held no later than June 15, 2024.
2022-003
The County requested reimbursement for the same expenditure twice. Context: We tested 22 grant expenditures for allowable activities, noting one of the expenditures charged to the grant was a duplicate. Questioned Costs: $20,740; reported as likely questioned costs exceed $25,000. Effect: The County requested for reimbursement for the same expenditure twice resulting in questioned costs. Cause: The report used to run grant expenditures used parameters that resulted in the same expenditure being reported twice when it was used to process the reimbursement request. Recommendation: We recommend the County review the reports with the program team to ensure all expenditures charged to the grant are complete and accurate and do not include any duplicates. Views of Responsible Officials: Management agrees with the finding and is implementing procedures to correct this, which is further discussed in the corrective action plan.
Show full finding ▾Hide full finding ▴U.S. Department of Public Health Federal Program Name: ELC Assistance Listing Number: 93.323 Significant Deficiency and Non-Material Non-Compliance - Activities Allowed & Allowable Costs Finding 2023-002 Criteria: In accordance with Section 200.303 of the Uniform Guidance, a non-federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Additionally, the County is required to adhere to the cost principles in Title 2 CFR Subpart E for allowable costs and activities. Condition: The County requested reimbursement for the same expenditure twice. Context: We tested 22 grant expenditures for allowable activities, noting one of the expenditures charged to the grant was a duplicate. Questioned Costs: $20,740; reported as likely questioned costs exceed $25,000. Effect: The County requested for reimbursement for the same expenditure twice resulting in questioned costs. Cause: The report used to run grant expenditures used parameters that resulted in the same expenditure being reported twice when it was used to process the reimbursement request. Recommendation: We recommend the County review the reports with the program team to ensure all expenditures charged to the grant are complete and accurate and do not include any duplicates. Views of Responsible Officials: Management agrees with the finding and is implementing procedures to correct this, which is further discussed in the corrective action plan.
Finding 2023-002, Significant Deficiency – Allowable Costs Corrective Action Plan: Goal: To ensure that duplicative expenses are not drawn down in state funding. Plan: The County identified the duplicate transaction of $20,740 reported for drawdown for Project AA 362 was due to an issue with the reporting mechanism. Specifically, the report used to extract project costing details included a commitment number column, which inadvertently resulted in the creation of duplicate records for each commitment associated with a single invoice. Performance Improvement Strategies: To address this issue and prevent its recurrence in the future, immediate steps have already been taken. County Finance has amended the report to exclude the commitment number parameter, thereby eliminating the possibility of duplicate records being generated. Responsible Parties: Nursing Supervisor Brooke Hamby and Assistant Health Directors Nicole Priddy & Marie Stephens Timeframes: Brooke Hamby will reach out to the Division of Public Health, Women & Children’s Health/Children & Youth section, no later than June 15, 2024, to inform them of the Audit finding of this duplicate expense and request what the process is for returning the funds.
FAC accepted this audit on March 29, 2023 — management decision was due September 29, 2023.
While the County noted reviews had taken place, the County does not have a formal policy for supervisor reviews of eligibility determinations related to this program. Further, the County did not retain copies of all reviews that were completed during the year. Context: We tested a sample of 60 approved applications out of over 5,700 total applications approved during the year, in which it was noted the County did not have a formalized process for documenting their review of eligibility determinations. Effect: The County could have provided funding to ineligible recipients or amounts that exceeded the allowable limits which resulted in questioned costs. Questioned Costs: None. Cause: There is no formal policy or checklist to document the review process in place. Recommendation: We recommend the County develop a formal checklist that is specific to what is being reviewed for each approved application, including but not limited to reviewing income support documentation and the income limit calculation, and ensure it is being completed prior to disbursing funds to the applicant. Views of responsible officials: Management agrees with the finding and is implementing procedures to correct this which is further discussed in the corrective action plan. Corrective Action Plan: See Corrective Action Plan prepared by the County.
Show full finding ▾Hide full finding ▴U.S. Department of Health and Human Services Passed through the North Carolina Department of Health and Human Services Program Name: Low-Income Home Energy Assistance Program Federal Assistance Listing Number: 93.568 Material Weakness - Eligibility Finding 2022-002 Criteria: In accordance with Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition: While the County noted reviews had taken place, the County does not have a formal policy for supervisor reviews of eligibility determinations related to this program. Further, the County did not retain copies of all reviews that were completed during the year. Context: We tested a sample of 60 approved applications out of over 5,700 total applications approved during the year, in which it was noted the County did not have a formalized process for documenting their review of eligibility determinations. Effect: The County could have provided funding to ineligible recipients or amounts that exceeded the allowable limits which resulted in questioned costs. Questioned Costs: None. Cause: There is no formal policy or checklist to document the review process in place. Recommendation: We recommend the County develop a formal checklist that is specific to what is being reviewed for each approved application, including but not limited to reviewing income support documentation and the income limit calculation, and ensure it is being completed prior to disbursing funds to the applicant. Views of responsible officials: Management agrees with the finding and is implementing procedures to correct this which is further discussed in the corrective action plan. Corrective Action Plan: See Corrective Action Plan prepared by the County.
Finding 2022-002, Material Weakness - Eligibility Corrective Action Plan: Goal: To ensure eligibility determination related to income documentation and calculation is completed appropriately for all applications by auditing a minimum of 5% of all applications completed monthly per employee and retaining electronic copies of the audits in One Drive. Plan: Designated Supervisors/Managers, Senior Income Maintenance Caseworkers, and Quality Assurance staff will be tasked with auditing cases using the state audit form. Performance Improvement Strategies: 1. Errors will be discussed individually with staff via monthly conferences with their supervisor or member of the supervisory team. 2. Copies of audit forms will be shared with staff which will identify trends, areas of improvement and progress. 3. In-service training will be developed based on common errors offered throughout the fiscal year and for all staff who are responsible for administering this program. 4. The QA/Training department will collaborate with Economic Services to develop a checklist to review approved applications that includes income documentation and calculation to ensure timely benefits to customers. Responsible Parties: Energy Programs Team and Customer Care Center Team management as well as the Quality Assurance Team will perform second party audits on 5% of all processed Low-Income Household Energy Assistance Program applications. Timeframes: Audits will be completed and retained on a monthly basis by IMC III (Lead Worker), and supervisor.
The County did not follow up with individuals after reviews were complete in accordance with its policies on a consistent basis. Context: There were 14 instances out of 60 program participants tested in which the County did not remediate the errors identified timely. Effect: The caseworkers that had errors identified in their eligibility determinations were not notified timely of the issues which could result in on going error. Cause: The County has a policy in place but does not have a way to ensure the policy is being enforced. Recommendation: We recommend that the County assign individuals to ensure all reviews are taking place timely in accordance with its policy including timely follow up with case workers once the review is complete. Views of responsible officials: Management agrees with the finding and is implementing procedures to correct this which is further discussed in the corrective action plan. Corrective Action Plan: See Corrective Action Plan prepared by the County.
Show full finding ▾Hide full finding ▴U.S. Department of Health and Human Services Pass-through Entity: North Carolina Department of Health and Human Services Program Name: Medical Assistance Federal Assistance Listing Number: 93.778 Significant Deficiency ? Eligibility Finding 2022-003 Criteria: In accordance with Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition: The County did not follow up with individuals after reviews were complete in accordance with its policies on a consistent basis. Context: There were 14 instances out of 60 program participants tested in which the County did not remediate the errors identified timely. Effect: The caseworkers that had errors identified in their eligibility determinations were not notified timely of the issues which could result in on going error. Cause: The County has a policy in place but does not have a way to ensure the policy is being enforced. Recommendation: We recommend that the County assign individuals to ensure all reviews are taking place timely in accordance with its policy including timely follow up with case workers once the review is complete. Views of responsible officials: Management agrees with the finding and is implementing procedures to correct this which is further discussed in the corrective action plan. Corrective Action Plan: See Corrective Action Plan prepared by the County.
Finding 2022-003, Significant Deficiency - Eligibility Corrective Action Plan: Goal: To ensure necessary Medicaid corrections are made by caseworkers in a timely manner and verified as completed by Medicaid management and/or Quality Assurance staff. Plan: The County will include a due date to the auditing tool so that correction tasks request can be tracked and monitored for completion and accurateness. Eligibility errors will be given five business days to be completed by workers and Internal Controls will be completed in 10 business days as they may require streamlining or revamping of internal processes. Performance Improvement Strategies: 1. Training will be given to supervisors, lead workers, and QA staff on proper usage and monitoring of due date requirements added to the audit tool. 2. Copies of reports will be stored in the shared Teams Channel for Medicaid Services. Responsible Parties: Marissa D. Adams, Medicaid Services Division Director Timeframes: Training for the usage of an audit tool is to be held no later than June 30, 2023, and usage of to begin immediately after is completed.
2021-003
While the County noted it has a review process in place for submitted reports, there was no evidence that the review took place. Additionally, copies of certain reports submitted were not retained. Context: We tested nine reports out of thirty-eight submitted during the year and found all nine did not have evidence that a review took place prior to submission and the date it was submitted. Additionally, copies of four out of the nine reports had not been retained on file. Effect: We could not determine if the County was compliant with certain reporting requirements or that reports were reviewed and submitted timely. Cause: The County did not retain all reports submitted through the Treasury or State website including proof of review and date of submission. Recommendation: We recommend the County save a copy of all reports, along with evidence of all supporting documentation to the County?s records and including who prepared and reviewed the report prior to submission. Views of responsible officials: Management agrees with the finding and is implementing procedures to correct this, which is further discussed in the corrective action plan.
Show full finding ▾Hide full finding ▴U.S. Department of Treasury Federal Program Name: Emergency Rental Assistance Program Assistance Listing Number 21.023 Significant Deficiency and Non-Material Non-Compliance - Reporting Finding 2022-004 Criteria: In accordance with Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition: While the County noted it has a review process in place for submitted reports, there was no evidence that the review took place. Additionally, copies of certain reports submitted were not retained. Context: We tested nine reports out of thirty-eight submitted during the year and found all nine did not have evidence that a review took place prior to submission and the date it was submitted. Additionally, copies of four out of the nine reports had not been retained on file. Effect: We could not determine if the County was compliant with certain reporting requirements or that reports were reviewed and submitted timely. Cause: The County did not retain all reports submitted through the Treasury or State website including proof of review and date of submission. Recommendation: We recommend the County save a copy of all reports, along with evidence of all supporting documentation to the County?s records and including who prepared and reviewed the report prior to submission. Views of responsible officials: Management agrees with the finding and is implementing procedures to correct this, which is further discussed in the corrective action plan.
Finding 2022-004, Significant Deficiency and Non-Material Non-Compliance - Reporting Corrective Action Plan: Goal: To ensure US Treasury reports are submitted timely and accurately, the County will log into the US Treasury website to download and save copies of previously submitted ERAP reports. Plan: The County will retain a repository with internally reviewed and uploaded reports. Performance Improvement Strategies: 1. Prior to March 10, 2023, reports that were submitted in the US Treasury website related to ERAP were not able to be saved/retained. 2. Leadership will log into the US Treasury website and download all prior reports submitted + will continue to download and save reports submitted henceforth. 3. All staff who participate in the submission of reports will sign and date the submitted report to verify internal review of information submitted. 4. Copies of reports will be stored in the shared Teams Channel for ERAP. 5. Supporting reports/documentation and meetings related to US Treasury reports will be retained via printed/signed copies. Responsible Parties: Mia Stockton, Economic Services Division Director Timeframes: Prior reports submitted will be downloaded and retained no later than 3/17/2023. Future reports/updates to reports will be retained upon submission.
We were not able to obtain one of the family service agreements required to be completed during the year under audit due to turnover and the County not having a formalized policy in place. Context: There was one instance out of 25 program participants tested where the family service agreement could not be provided for the period under audit. The County was able to provide a family service agreement completed for the period prior and subsequent to the period under audit. Effect: The County was not in compliance with forms that are required to be completed each year that a child is in the Foster Care system. Cause: The County did not have a process in place ensure the form is completed timely and kept on file when turnover occurs. Recommendation: We recommend the County implement a process to ensure the Family Services Agreement is completed timely and retained on file. Views of responsible officials: Management agrees with the finding and is implementing procedures to correct this, which is further discussed in the corrective action plan.
Show full finding ▾Hide full finding ▴U.S. Department of Health and Human Services Federal Program Name: Foster Care and Adoption Assistance Assistance Listing Number 93.658; 93.659 Non-Material Non-Compliance - Eligibility Finding 2022-005 Criteria: In accordance with Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition: We were not able to obtain one of the family service agreements required to be completed during the year under audit due to turnover and the County not having a formalized policy in place. Context: There was one instance out of 25 program participants tested where the family service agreement could not be provided for the period under audit. The County was able to provide a family service agreement completed for the period prior and subsequent to the period under audit. Effect: The County was not in compliance with forms that are required to be completed each year that a child is in the Foster Care system. Cause: The County did not have a process in place ensure the form is completed timely and kept on file when turnover occurs. Recommendation: We recommend the County implement a process to ensure the Family Services Agreement is completed timely and retained on file. Views of responsible officials: Management agrees with the finding and is implementing procedures to correct this, which is further discussed in the corrective action plan.
Finding 2022-005, Non-Material Non-Compliance - Eligibility Corrective Action Plan: Goal: To ensure timely completion, review, and all required signatures are obtained on the Family Services Agreements and retained on file. Plan: The County will require F&C Supervisors to log the most recent PPR/CFT meetings on the monthly spreadsheet to track when the next FSA will be due for review. Performance Improvement Strategies: 1. All PPR/CFT meetings will be held for each child in FC DSS custody every three months. 2. The meeting includes but is not limited to completion of FSAs and any other review tools necessary. All completed forms will have two-level review and signature and be maintained in the record. 3. The F&C Division already has a monthly spreadsheet to track monthly contact with youth in care. Two additional columns will be added to track the most recent meeting/form and the second column will target when the next id due to be reviewed. 4. All Supervisors will be expected to complete the two additional columns monthly recording the date of the last FSA review and projecting the next FSA review due date. 5. The Program Manager and Division Director will review the spreadsheet monthly to ensure that all FSAs have been completed timely. 6. In the event that an FSA is found to be untimely, the Supervisor/Program Manager/Division Director will ensure that the assigned caseworker completes the FSA review within 5 business days and routes any untimely forms for Program Manager review. Responsible Parties: Family & Children?s Services Division Director, Foster Care/Adoptions Program Manager, All Foster Care Supervisors, and Social Workers Timeframes: Policy will be communicated to responsible parties no later than April 1, 2023 and implemented effective immediately.
FAC accepted this audit on January 2, 2022 — management decision was due July 2, 2022.
We noted 1 instance where adequate case documentation to substantiate claims entered intothe NCFAST Enterprise Program Integrity (EPI) was not maintained.Context: We sampled 7 claim files that were entered into the EPI system. We noted the above condition in 1of the 7 files tested.
Show full finding ▾Hide full finding ▴Finding 2021-002, Significant Deficiency over Special Tests and Provisions and Non-Material NoncomplianceInformation on the federal program: DSS Crosscutting, U.S. Department of Social Services, passed throughthe N.C Department of Health and Human Services, Division of Social Services, Medicaid Cluster, CFDA93.778.Criteria or specific requirement: Per North Carolina DSS Crosscutting compliance supplement: ?Countiesmust maintain adequate case documentation to substantiate the claim entry into EPI. This informationincludes but is not limited to the dates of the overpayment period, documentary evidence to substantiatethat an overpayment occurred, such as wage stubs or verification from an employer, other incomeverification and household composition verification, and the budgets used to compute the amount of theoverpayment.? Effect: The County does not have supporting documentation for claims entered into EPI. There is a riskclaims may not be valid.Cause: Internal Controls surrounding the submittal of cases to EPI are not in place.Recommendation: County DSS staff need to ensure that all documentation is maintained and matches whatis entered into EPI.Condition: We noted 1 instance where adequate case documentation to substantiate claims entered intothe NCFAST Enterprise Program Integrity (EPI) was not maintained.Context: We sampled 7 claim files that were entered into the EPI system. We noted the above condition in 1of the 7 files tested.
Finding 2021-002, Significant Deficiency over Special Tests and Provisions and Non-Material NoncomplianceName of Contact Person: Mia StocktonSummary of Finding: Noted one instance where adequate case documentation to substantiate claims entered in theNCFAST Enterprise Program Integrity (EPI) was not maintained. Internal controls surrounding the submittal of EPIare not in place. 1 of 7 files tested.Corrective Action Plan: The County implemented a Quality Assurance Plan (QAP) effective October 1, 2020. Theplan establishes a continuous quality improvement (CQI) process that requires five upfront substantiated cases andfive unsubstantiated cases for Program Integrity (PI). Cases identified as Intentional Program Violation (IPV) requiresa second- and third-party review. The QAP established the process of transitioning all PI cases October 1, 2020,forward, including documentation and support evidence entered in NCFAST. The CQI process requires the PISupervisor to complete audits on 100% of all cases and to sign off an PI recommendation. *(The county acknowledgessome case files may be unable to locate due to agency flood in 2016). Supervisor conducts monthly conferences andreviews second party audit findings.Proposed Completion Date: Program Integrity Training: December 10, 2021 ? Audit Findings, documentation tosubstantiate claims entered NCFAST.
Finding 2021-003, Significant Deficiency over EligibilityInformation on the federal program: Medicaid Cluster (Medicaid), CFDA 93.778, U.S. Department of Healthand Human Services, passed through the N.C Department of Health and Human Services, Division of MedicalAssistance.Criteria or specific requirement: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX)Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and ChildrenMedicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistanceare required to retain documentation to evidence appropriate eligibility determination, including:? verifications of North Carolina State Residency? accurate record of household members and relationships? verification of real property ownership? accurate computation of countable income and resourcesConditions: We noted that in two instances the case record did not contain documentation evidencing thattax and Register of Deeds? records were checked to verify whether the individual owns property. In twelveinstances, the total countable income was not recorded accurately into NC FAST based upon documentationin the case record. In one instance, the case record did not contain two acceptable verifications of stateresidency or applicant?s statement the applicant was unable to obtain two sources of state residency. In fourinstances, the case record did not contain evidence that the household and relationship information toverify household composition.Context: We sampled 93 payments from a total population of 7,823,218 payments. We noted the aboveconditions in 16 of the 93 case files inspected. No questioned costs identified as a result of missingdocumentation in files. Effect: Case files not containing all required documentation result in a risk that the County could provideservices to individuals not eligible to receive such services or that such services could be denied to eligibleindividuals. Subsequent to being notified that required documentation had not been retained in case files,the County was able obtain documentation to substantiate that the applicants tested were eligible toreceive benefits.Cause: The County did not retain required documentation in case files at the time eligibility was determined. Recommendation: We recommend that the County train and monitor employees on the eligibilitydetermination process. We also recommend the County review and amend current policy and procedures inplace to ensure that all eligibility determination documentation is completed and retained by the County.
Show full finding ▾Hide full finding ▴Finding 2021-003, Significant Deficiency over EligibilityInformation on the federal program: Medicaid Cluster (Medicaid), CFDA 93.778, U.S. Department of Healthand Human Services, passed through the N.C Department of Health and Human Services, Division of MedicalAssistance.Criteria or specific requirement: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX)Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and ChildrenMedicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistanceare required to retain documentation to evidence appropriate eligibility determination, including:? verifications of North Carolina State Residency? accurate record of household members and relationships? verification of real property ownership? accurate computation of countable income and resourcesConditions: We noted that in two instances the case record did not contain documentation evidencing thattax and Register of Deeds? records were checked to verify whether the individual owns property. In twelveinstances, the total countable income was not recorded accurately into NC FAST based upon documentationin the case record. In one instance, the case record did not contain two acceptable verifications of stateresidency or applicant?s statement the applicant was unable to obtain two sources of state residency. In fourinstances, the case record did not contain evidence that the household and relationship information toverify household composition.Context: We sampled 93 payments from a total population of 7,823,218 payments. We noted the aboveconditions in 16 of the 93 case files inspected. No questioned costs identified as a result of missingdocumentation in files. Effect: Case files not containing all required documentation result in a risk that the County could provideservices to individuals not eligible to receive such services or that such services could be denied to eligibleindividuals. Subsequent to being notified that required documentation had not been retained in case files,the County was able obtain documentation to substantiate that the applicants tested were eligible toreceive benefits.Cause: The County did not retain required documentation in case files at the time eligibility was determined. Recommendation: We recommend that the County train and monitor employees on the eligibilitydetermination process. We also recommend the County review and amend current policy and procedures inplace to ensure that all eligibility determination documentation is completed and retained by the County.
Finding 2021-003, Significant Deficiency over EligibilityName of Contact Person: Mia StocktonSummary of Finding: The County did not retain required documentation in case file at the time eligibility wasdetermined. Case file not containing all required documentation was noted in 16 of the 93 case files inspected.Corrective Action Plan: The county implemented a Quality Assurance Plan (QAP) effective October 1, 2020. Theplan establishes a continuous quality improvement (CQI) process that requires lead workers and/or supervisors tocomplete monthly second party review audits with a 5% threshold of audits per month, per worker. In addition, thecounty must submit a quarterly report to The Office of Compliance and Program Integrity (OCPI) with a minimum of382 case reviews by the 20th of the month following the quarter. As outlined in Forsyth County QAP a second partyreview must audit application approvals, denials, and withdrawals in three categories, Eligibility Error, Negative CaseOutcomes, and Internal Errors. Lead workers and or/supervisors must use the county created automated audit tool thatencompasses requirements outlined in the State Audit Form: DMA-7078. Probationary Status/permanent staff mustadhere to the State requirements of passing 70% Core training and programmatic Level 1 training. NC LearningGateway, Level 1 training require staff to apply learned Medicaid policy in a virtual case action, which includesknowledge checks and quizzes. Probationary status employees must remain on 100% audit checks for a minimum of1-month beyond the Core/Level 1 training. Programmatic trainings are held quarterly based on the CAP errors/trendsand any other identified opportunities for CQI. Supervisor(s) conduct monthly conferences and review second partyaudit findings with staff.Proposed Completion Date: Medicaid Program Trainings Completed:? November 13, 2020 ? OVS, 5097?s, 5001, COVID Admin Letter, Keying Deductibles in NCFAST? January 27, 2021 ? NC Residency, Budgeting, Deductibles ? How to Calculate, 5003, OVS, Dictation? March 1, 2021 ? Voter Registration, Managing NCFAST Evidence, Dictation/documentation of case file,Incorrect Notices, Incorrect Income budgeting, Types of UIB (Countable/Uncountable), TerminatedIncome, Non-Countable Income, Deductibles- How to calculate? April 14 & 15 2021 ? How to Add continued eligibility, how to process recertifications? June 10, 2021, Person Pages ? How to cleanup (FC Best Practice)? June 15, 2021 ? Managed Care, Continued Eligibility? August 5, 2021 ? Reasonable Compatibility, 20020?s, how to properly complete 5003, Unearned incomeRSDI vs SSI, earned income budgeting/keying, verifications, missing evidence, Citizenship documentation,managed care, continued eligibility vs termination during PHE, MCV? October 21, 2021 ? Admin Letter 7-21, Notices (8110, 5003) Budget/Income, Tax Relationships, Tax filingstatus ? how to enter correctly, documentation, Earned/Unearned income ? Keying errors, Medical Force,Person Page, addresses, contact preferences, Admin Letter 7-21, Change Notice 10-21, person search andregistration? November 17 & 19, 2021 ? Policy Updates/Clarifications from OSTo NCFAST Magi Medicaid Competencieso Basic Deductibleo Addresses, Phone Numbers Demographics Information Identifications
FAC accepted this audit on January 12, 2021 — management decision was due July 12, 2021.
We noted 5 instances where adequate case documentation to substantiate claims entered into the NCFAST Enterprise Program Integrity (EPI) was not maintained. Context: We sampled 40 claim files that were entered into the EPI system. We noted the above condition in 5 of the 40 files tested. Effect: The County does not have supporting documentation for claims entered into EPI. There is a risk claims may not be valid. Cause: Internal Controls surrounding the submittal of cases to EPI are not in place. Recommendation: County DSS staff need to ensure that all documentation is maintained and matches what is entered into EPI.
Show full finding ▾Hide full finding ▴Finding 2020-001, Significant Deficiency over Special Tests and Provisions and Non-Material Noncompliance Information on the federal program: DSS Crosscutting, U.S. Department of Social Services, passed through the N.C Department of Health and Human Services, Division of Social Services, Supplemental Nutrition Assistance Program, CFDA 10.551, Child Support Enforcement, CFDA 93.563 and Medicaid Cluster, CFDA 93.778. Criteria or specific requirement: Per North Carolina DSS Crosscutting compliance supplement: ?Counties must maintain adequate case documentation to substantiate the claim entry into EPI. This information includes but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.? Condition: We noted 5 instances where adequate case documentation to substantiate claims entered into the NCFAST Enterprise Program Integrity (EPI) was not maintained. Context: We sampled 40 claim files that were entered into the EPI system. We noted the above condition in 5 of the 40 files tested. Effect: The County does not have supporting documentation for claims entered into EPI. There is a risk claims may not be valid. Cause: Internal Controls surrounding the submittal of cases to EPI are not in place. Recommendation: County DSS staff need to ensure that all documentation is maintained and matches what is entered into EPI.
Finding 2020-001, Significant Deficiency over Special Tests and Provisions and Non-Material Noncompliance Name of Contact Person: Mia Stockton Summary of Finding: Supporting documentation/and or case record not located for 5 of the 40 files entered into EPICS system. Corrective Action Plan: Staff changes and implemented Internal Controls as of July 1, 2020. Staff changes include reassignment of a Program Manager, to oversee the daily operations in the Program Integrity unit. The assigned program manager has fifteen plus years in the Economic Service Division; with ten years of direct management in the Program Integrity Unit. Program manager will facilitate or arrange classroom training and develop/organize additional in-service training for all staff. Supervisor of the unit will meet with staff on an individual level monthly or bi-monthly to review error findings from internal audits. Internal Controls implemented: Program Integrity case documentation/supporting documentation direct input into NCFAST; paper case records prior to July 2020 stored in one designated file room; and an excel spreadsheet maintained by Supervisor/Program Manager documenting unsubstantiated case files. Economic Services Division (All Service lines) migration to a document management system Laser fiche implementation date 2021. Proposed completion date: July 2020/continuous
Finding 2020-002, Significant Deficiency over Eligibility Information on the federal program: Medicaid Cluster (Medicaid), CFDA 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Medical Assistance. Criteria or specific requirement: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to evidence appropriate eligibility determination, including: ? verifications of North Carolina State Residency ? accurate record of household members and relationships ? verification of social security number ? verification of real property ownership ? accurate computation of countable income and resources ? verification of earned income ? verification of unearned income Conditions: We noted that in four instances the case record did not contain documentation evidencing that tax and Register of Deeds? records were checked to verify whether the individual owns property. In eight instances, the total countable income was not recorded accurately into NC FAST based upon documentation in the case record. In one instance, the case record did not contain two acceptable verifications of state residency or applicant?s statement the applicant was unable to obtain two sources of state residency. In one instance, casefile did not contain a completed DMV OVS. In six instances, the case record did not contain evidence that the household and relationship information to verify household composition. In eleven instances, SOLQ OVS/ OLV, Bendex OVS/OLV, SDX OVS, ESC OVS, and ACTS OVS were not completed to verify the individual?s unearned income. In one instance, the case record did not contain evidence that the State Online Query OVS (SOLQ) was completed to verify the individual?s Social Security Number (SSN). In one instance, the case record did not contain an appropriate income conversion and computation in accordance with policy manuals. In six instances, the Employment Security Commission (ESC) OVS was not completed to verify the individual?s earned income. Context: We sampled 93 payments from a total population of 6,682,282 payments. We noted the above conditions in 23 of the 93 case files inspected. Effect: Case files not containing all required documentation result in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. Subsequent to being notified that required documentation had not been retained in case files, the County was able obtain documentation to substantiate that the applicants tested were eligible to receive benefits. Cause: The County did not retain required documentation in case files at the time eligibility was determined. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County.
Show full finding ▾Hide full finding ▴Finding 2020-002, Significant Deficiency over Eligibility Information on the federal program: Medicaid Cluster (Medicaid), CFDA 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Medical Assistance. Criteria or specific requirement: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to evidence appropriate eligibility determination, including: ? verifications of North Carolina State Residency ? accurate record of household members and relationships ? verification of social security number ? verification of real property ownership ? accurate computation of countable income and resources ? verification of earned income ? verification of unearned income Conditions: We noted that in four instances the case record did not contain documentation evidencing that tax and Register of Deeds? records were checked to verify whether the individual owns property. In eight instances, the total countable income was not recorded accurately into NC FAST based upon documentation in the case record. In one instance, the case record did not contain two acceptable verifications of state residency or applicant?s statement the applicant was unable to obtain two sources of state residency. In one instance, casefile did not contain a completed DMV OVS. In six instances, the case record did not contain evidence that the household and relationship information to verify household composition. In eleven instances, SOLQ OVS/ OLV, Bendex OVS/OLV, SDX OVS, ESC OVS, and ACTS OVS were not completed to verify the individual?s unearned income. In one instance, the case record did not contain evidence that the State Online Query OVS (SOLQ) was completed to verify the individual?s Social Security Number (SSN). In one instance, the case record did not contain an appropriate income conversion and computation in accordance with policy manuals. In six instances, the Employment Security Commission (ESC) OVS was not completed to verify the individual?s earned income. Context: We sampled 93 payments from a total population of 6,682,282 payments. We noted the above conditions in 23 of the 93 case files inspected. Effect: Case files not containing all required documentation result in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. Subsequent to being notified that required documentation had not been retained in case files, the County was able obtain documentation to substantiate that the applicants tested were eligible to receive benefits. Cause: The County did not retain required documentation in case files at the time eligibility was determined. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County.
Finding 2020-002, Significant Deficiency over Eligibility Name of Contact Person: Mia Stockton Summary of Finding: Caseworkers? failure to complete to submit OVS/OLV, and AVS electronic check resulted in enumeration, income both earned/unearned, social security and DMV unverified within NCFAST. OVS is the required verification match to identify any potential misinformation for all application/reviews in Family and Children?s Medicaid and OVS/OLV and AVS supports case actions for all Adult Medicaid as outlined in Medicaid policy. Failure to submit the electronic matches has potential for county responsible charge backs. Corrective Action Plan: Supervisors will conduct random checks of applications/reviews to ensure OVS/OLV and AVS verification checks are submitted. Additionally, workers must reconcile the returned data from the electronic systems prior to disposing of an application/review and document matches were completed. Supervisors will meet with staff on an individual level monthly or bi-monthly to review errors/audit findings. Staff will be held accountable initially with a verbal reminder, then proceed through the disciplinary process. Lead workers will continue to monitor and work with staff one-on-one to ensure information gained from training sessions is clear and practiced. Program Managers will facilitate classroom trainings and provide in-service training based on trends identified from the quality audit grade book for economic services and will conduct additional trainings when warranted. Additionally, staff is to reference NCFAST Learning Gateway for trainings and webinars for NCFAST navigation. Proposed completion date: Adult Medicaid training completion date 8.12.20; Family and Children?s Medicaid (Applications) completion date ? 3.20.19,9.13.19, 2.19.20, 7.30.20 & 8.11.20, ; Family and Children?s Medicaid (Recerts) completion date ? 10.7.19, 1.31.20 & 8.4.20.
2019-001
FAC accepted this audit on March 10, 2020 — management decision was due September 10, 2020.
Information on the federal program: Medicaid Cluster (Medicaid), CFDA 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Medical Assistance. Criteria or specific requirement: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to evidence appropriate eligibility determination, including: ? verifications of United States citizenship ? verifications of North Carolina State Residency ? accurate record of household members and relationships ? verification of social security number ? verification of real property ownership ? accurate computation of countable income and resources ? verification of earned income ? verification of unearned income ? verification of date of birth Conditions: We noted that in six instances the case record did not contain documentation evidencing that tax and Register of Deeds? records were checked to verify whether the individual owns property. In eight instances, the case record did not contain two acceptable verifications of state residency or applicant?s statement the applicant was unable to obtain two sources of state residency. In seven instances, the case record did not contain evidence that the household and relationship information to verify household composition. In four instances, the Employment Security Commission (ESC) OVS was not completed to verify the individual?s earned income. In five instances, SOLQ OVS/ OLV, Bendex OVS/OLV, SDX OVS, ESC OVS, and ACTS OVS were not completed to verify the individual?s unearned income. In four instances, the case record did not contain evidence that the State Online Query OVS (SOLQ) was completed to verify the individual?s Social Security Number (SSN). In nine instances, the case record did not contain an appropriate income conversion and computation in accordance with policy manuals. In eleven instances, the total countable income was not recorded accurately into NC FAST based upon documentation in the case record. In six instances, the casefile did not contain an accurate and complete amount of total resources. In four instances, casefile did not contain a completed DMV OVS. In two instances, Asset Verification System (AVS) was not completed in NC FAST for the recertification period. In three instances, casefile did not contain evidence that the client's citizenship or alien status was verified. In one instance, casefile did not contain evidence that the client's birth date was verified. Context: We sampled 93 payments from a total population of 6,246,185 payments made to the participants during the fiscal year. We noted the above condition in 33 of the 93 case files inspected for applicable payments. Effect: Case files not containing all required documentation result in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. Subsequent to being notified that required documentation had not been retained in case files, the County was able obtain documentation to substantiate that the applicants tested were eligible to receive benefits. Cause: The County did not retain required documentation in case files at the time eligibility was determined. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County.
Show full finding ▾Hide full finding ▴Information on the federal program: Medicaid Cluster (Medicaid), CFDA 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Medical Assistance. Criteria or specific requirement: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), case files for individuals or families receiving assistance are required to retain documentation to evidence appropriate eligibility determination, including: ? verifications of United States citizenship ? verifications of North Carolina State Residency ? accurate record of household members and relationships ? verification of social security number ? verification of real property ownership ? accurate computation of countable income and resources ? verification of earned income ? verification of unearned income ? verification of date of birth Conditions: We noted that in six instances the case record did not contain documentation evidencing that tax and Register of Deeds? records were checked to verify whether the individual owns property. In eight instances, the case record did not contain two acceptable verifications of state residency or applicant?s statement the applicant was unable to obtain two sources of state residency. In seven instances, the case record did not contain evidence that the household and relationship information to verify household composition. In four instances, the Employment Security Commission (ESC) OVS was not completed to verify the individual?s earned income. In five instances, SOLQ OVS/ OLV, Bendex OVS/OLV, SDX OVS, ESC OVS, and ACTS OVS were not completed to verify the individual?s unearned income. In four instances, the case record did not contain evidence that the State Online Query OVS (SOLQ) was completed to verify the individual?s Social Security Number (SSN). In nine instances, the case record did not contain an appropriate income conversion and computation in accordance with policy manuals. In eleven instances, the total countable income was not recorded accurately into NC FAST based upon documentation in the case record. In six instances, the casefile did not contain an accurate and complete amount of total resources. In four instances, casefile did not contain a completed DMV OVS. In two instances, Asset Verification System (AVS) was not completed in NC FAST for the recertification period. In three instances, casefile did not contain evidence that the client's citizenship or alien status was verified. In one instance, casefile did not contain evidence that the client's birth date was verified. Context: We sampled 93 payments from a total population of 6,246,185 payments made to the participants during the fiscal year. We noted the above condition in 33 of the 93 case files inspected for applicable payments. Effect: Case files not containing all required documentation result in a risk that the County could provide services to individuals not eligible to receive such services or that such services could be denied to eligible individuals. Subsequent to being notified that required documentation had not been retained in case files, the County was able obtain documentation to substantiate that the applicants tested were eligible to receive benefits. Cause: The County did not retain required documentation in case files at the time eligibility was determined. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that all eligibility determination documentation is completed and retained by the County.
Name of Contact Person: Mia L. Stockton, Economic Services Division Director Summary of Finding: Caseworkers? failure to document and upload the required verification of evidence used to verify tax/register of deeds, state residency, and resources was an omission of required documentation/verification to support case actions, as outlined by Medicaid policy. Corrective Action Plan: Economic Services division implemented a quality audit tool as of July 1, 2019. The Quality tool audits appropriate documentation/verification for required notices, income/budgeting, resources and disability, assigns a percentage of accuracy for each worker audited and outlines error trends for training. In-Service refresher face-to-face training on required verifications and documentation of case records for all Adult Medicaid staff, January 2019. Subsequent team meetings/huddles after January 2019 continue to highlight the required verifications/documentation. Supervisors will meet with staff on an individual level monthly or bi-monthly to review errors/audit findings. Lead workers will continue to mentor and work with staff one-on-one to ensure information gained from training sessions is clear and practiced. Training/Quality Assurance team will facilitate classroom trainings and provide in-service training based on trends identified from the quality audit gradebook for economic services and will conduct any additional trainings arranged by Program Manager or Supervisors. Program Manager will facilitate or arrange classroom training and develop/organize additional in-service training for all staff. Future training to conclude by February 2020 staff must complete the Financial Resource Training and review the AVS training located in the NC Learning Gateway. The program area continues to conduct second party review on active cases. Each audit is modeled after the States? quality tool which includes proof of required verifications and documentation. Staff will be held accountable initially with a verbal reminder, then proceed through the disciplinary process. Proposed completion date: February 2020
One individual received benefits when his countable income exceeded the MAGI Medicaid income limits. Questioned cost: The known questioned cost was $4. Context: We sampled 93 payments of 6,246,185 payments. We noted the conditions above were contained in 1 of the 93 case files inspected. Effect: Individuals with countable income over the MAGI Medicaid income limit were incorrectly deemed eligible to receive Medicaid. The known questioned cost was $4. Cause: Incorrect countable income was entered into NCFAST. Finding 2019-002, Significant Deficiency over Eligibility and Non-Material Noncompliance, continued Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures to ensure countable income is verified and accurately recorded in NC FAST during the eligibility determination process.
Show full finding ▾Hide full finding ▴Information on the federal program: Medicaid Cluster (Medicaid), CFDA 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Medical Assistance. Criteria or specific requirement: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), to be eligible to receive benefits under this program the individual must have countable resources below the MAGI Medicaid income limits associated with the individual?s household composition. Condition: One individual received benefits when his countable income exceeded the MAGI Medicaid income limits. Questioned cost: The known questioned cost was $4. Context: We sampled 93 payments of 6,246,185 payments. We noted the conditions above were contained in 1 of the 93 case files inspected. Effect: Individuals with countable income over the MAGI Medicaid income limit were incorrectly deemed eligible to receive Medicaid. The known questioned cost was $4. Cause: Incorrect countable income was entered into NCFAST. Finding 2019-002, Significant Deficiency over Eligibility and Non-Material Noncompliance, continued Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures to ensure countable income is verified and accurately recorded in NC FAST during the eligibility determination process.
Name of Contact Person: Mia L. Stockton, Economic Services Division Director Summary of Finding: Caseworkers? failure to submit the OVS/OLV and AVS electronic check resulted in enumeration, income both earned/unearned, social security and DMV unverified within NCFAST. OVS is the required electronic verification match to identify any potential misinformation for all application/reviews in Family and Children?s Medicaid and OVS/OLV and AVS supports case actions for all Adult Medicaid as outlined in Medicaid policy. Failure to submit the electronic matches has potential for county responsible chargebacks. Corrective Action Plan: Supervisors will conduct random checks of applications/reviews to ensure OVS/OLV and AVS are submitted. Additionally, workers must reconcile the returned data from the electronic systems prior to disposing of an application/review and document the matches were completed. Supervisors will meet with staff on an individual level monthly or bi-monthly to review errors/audit findings. Staff will be held accountable initially with a verbal reminder, then proceed through the disciplinary process. Lead workers will continue to mentor and work with staff one-on-one to ensure information gained from training sessions is clear and practiced. Training/Quality Assurance team will facilitate classroom trainings and provide in-service training based on trends identified from the quality audit gradebook for economic services and will conduct any additional trainings arranged by Program Manager or Supervisors. Program Manager will facilitate or arrange classroom training and develop/organize additional in-service training for all staff. Proposed completion date: Implemented January 2019, continuous.
We noted in one instance, an individual converted from SSI to regular Medicaid on 1/1/19 and the Ex Parte review was not done until 7/31/19. Questioned cost: The known questioned cost totaled $278. Context: We sampled 93 case files from a total population of 6,246,185 files. We noted the above conditions in 1 of the 93 case files inspected. Effect: The County provided services to an individual not eligible to participate in such services resulting in claims paid on behalf of an ineligible participant. The known questioned cost totaled $278. Cause: The Ex Parte review was not performed within 120 days after conversion. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that all Ex Parte review is completed timely to determine Medicaid eligibility.
Show full finding ▾Hide full finding ▴Information on the federal program: Medicaid Cluster (Medicaid), CFDA 93.778, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Medical Assistance. Criteria or specific requirement: Per the North Carolina Medicaid Assistance Program (Medicaid; Title XIX) Compliance Supplement and the DSS manuals (Aged, Blind and Disabled manual, Family and Children Medicaid manual and the Integrated Policy manual), after Supplemental Security Income (SSI) is terminated, the individual must be determined eligible for other Medicaid programs. Within 4 months of the month the SSI terminated, the County DSS must complete the evaluation of ongoing eligibility and notify the recipient about his ongoing eligibility for Medicaid. The 4 month period begins the month the case appears on the SSI Termination Report. Condition: We noted in one instance, an individual converted from SSI to regular Medicaid on 1/1/19 and the Ex Parte review was not done until 7/31/19. Questioned cost: The known questioned cost totaled $278. Context: We sampled 93 case files from a total population of 6,246,185 files. We noted the above conditions in 1 of the 93 case files inspected. Effect: The County provided services to an individual not eligible to participate in such services resulting in claims paid on behalf of an ineligible participant. The known questioned cost totaled $278. Cause: The Ex Parte review was not performed within 120 days after conversion. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that all Ex Parte review is completed timely to determine Medicaid eligibility.
Name of Contact Person: Mia L. Stockton, Economic Services Division Director Corrective Action Plan: Income Maintenance caseworkers who evaluate the foster care cases will now be required to attend all Medicaid trainings. The Income Maintenance caseworker will ensure any 5120 received with a signature prior to submission be returned and a new 5120 be generated and signatures obtained based on the order outlined in Medicaid policy. Supervisors will meet with staff on an individual level monthly or bi-monthly to review errors/audit finding. Program Manager will facilitate or arrange classroom training and develop/organize additional in-service training for all staff. Proposed completion date: Implemented October 2019, continuous.
We noted in six instances, the Income Maintenance Case Worker signed the income determination section of form DSS-5120 after the social worker and supervisor had determined eligibility. Context: We sampled 93 cases from a total population of 252 participants. We noted the above conditions in 6 of the 93 case files inspected. Effect: Income determination occurring after eligibly determination and benefits establishment results in a risk that the County could provide services to individuals not eligible to receive such services. Cause: The Income Maintenance Case Worker did not perform income determination until after the social worker and supervisor determined the participant eligible. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that all eligibility determination documentation is completed and signed on time and retained by the County.
Show full finding ▾Hide full finding ▴Information on the federal program: Foster Care and Adoption Cluster, CFDA 93.658 and 93.659, U.S. Department of Health and Human Services Administration for Children and Families, passed through the N.C Department of Health and Human Services, Division of Social Services. Criteria or specific requirement: Per the NC Child Welfare Funding Manual and the DSS-5120 form for determination of Foster Care Assistance Benefits the Income Maintenance Case Worker should complete the income determination prior to the social worker and supervisor making the determination of IV-E eligibility. Condition: We noted in six instances, the Income Maintenance Case Worker signed the income determination section of form DSS-5120 after the social worker and supervisor had determined eligibility. Context: We sampled 93 cases from a total population of 252 participants. We noted the above conditions in 6 of the 93 case files inspected. Effect: Income determination occurring after eligibly determination and benefits establishment results in a risk that the County could provide services to individuals not eligible to receive such services. Cause: The Income Maintenance Case Worker did not perform income determination until after the social worker and supervisor determined the participant eligible. Recommendation: We recommend that the County train and monitor employees on the eligibility determination process. We also recommend the County review and amend current policy and procedures in place to ensure that all eligibility determination documentation is completed and signed on time and retained by the County.
Name of Contact Person: Mia L. Stockton, Economic Services Division Director Summary of Finding: Caseworkers? failure to complete the SSI Exparte within the 120-day time frame as outlined in Medicaid policy resulted in a known question cost of $278. Corrective Action Plan: Workflow and staff changes as of September 1, 2019 include one dedicated caseworker for Family and Children?s and one dedicated staff for Adult. These individuals serve as back-up for each other. Dedicated staff to complete SSI Expartes will alert supervisors/program manager of any issues or concerns prior to the 120-day timeframe if unable to access required verifications to complete an evaluation. Supervisors will meet with staff on an individual level monthly or bi-monthly to review errors/audit finding. Lead workers will continue to mentor and work with staff one-on-one to ensure information gained from training sessions is clear and practiced. Training/Quality Assurance team will facilitate classroom trainings and provide in-service training based on trends identified from the quality audit gradebook for economic services. And, quality team will conduct any additional trainings arranged by Department of Social Services Program Manager or Supervisors. Program Manager will facilitate or arrange classroom training and develop/organize additional in-service training for all staff. Proposed completion date: SSI Expartes to date are current and being evaluated within the 120-day time frame.
We noted that in three instances, income verification was not completed during the review or application for the individuals. Context: We sampled 93 case files of a total of 8,402 cases. We noted the above condition in 3 of the 93 inspected files. Effect: Ineligible individuals could have received benefits due to insufficient verification of information by a caseworker. Subsequent to being notified that income verification documentation had not been retained in case files, the County was able to obtain documentation to substantiate that the applications tested were eligible to receive benefits. Cause: Internal controls are not in place to ensure the proper documentation and verification is completed and a DSS caseworker reviews the documentation. Recommendation: We recommend that the County continue to train and monitor employees on the eligibility application process to ensure eligibility procedures are completed appropriately and are reviewed by the DSS caseworker and retained by the County.
Show full finding ▾Hide full finding ▴Information on the federal program: Low Income Home Energy Assistance, CFDA 93.568, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Social Services. Criteria or specific requirement: Per the North Carolina Low-Income Energy Assistance Program Compliance Supplement, local agencies must accurately record the household?s income. Condition: We noted that in three instances, income verification was not completed during the review or application for the individuals. Context: We sampled 93 case files of a total of 8,402 cases. We noted the above condition in 3 of the 93 inspected files. Effect: Ineligible individuals could have received benefits due to insufficient verification of information by a caseworker. Subsequent to being notified that income verification documentation had not been retained in case files, the County was able to obtain documentation to substantiate that the applications tested were eligible to receive benefits. Cause: Internal controls are not in place to ensure the proper documentation and verification is completed and a DSS caseworker reviews the documentation. Recommendation: We recommend that the County continue to train and monitor employees on the eligibility application process to ensure eligibility procedures are completed appropriately and are reviewed by the DSS caseworker and retained by the County.
Name of Contact Person: Mia L. Stockton, Economic Services Division Director Summary of Finding: Caseworkers? failure to utilize the evidence dashboard correctly resulting in countable income not recorded correctly and the income wizard within NCFAST not used correctly. Corrective Action Plan: The second party audit tool will assist in identifying caseworkers who continue to struggle with submitting evidence properly within NCFAST and those caseworkers identified will receive additional one-on-one training by a lead worker or supervisor on keying into NCFAST. The goal is to ensure documentation of income in the case file matches information submitted on the evidence dashboard. Supervisors/Program Managers will continue to review errors in individual conferences and program meetings with staff. Staff will be held accountable initially with a verbal reminder, then proceed through the disciplinary process. Proposed completion date: February 2020.
We noted that in five instances the Denial Notice form DSS-8107 was not marked sent in NC Fast. In one instance, the Approval/Denial notice form DSS-8107 was not completed and reviewed by the County?s DSS caseworker. Context: We sampled 46 of 1,512 total denied applications. We noted the above condition in 6 of the 46 inspected files. Effect: Case files containing a Denial Notice form 8107 that is not sent to applicants results in a risk that the denied or approved applicants are not receiving timely communication or an opportunity for a hearing. Cause: Internal controls were not in place to ensure the Approval/ Denial Notice for DSS 8107 is completed, reviewed and sent in NC FAST. Recommendation: We recommend that the County continue to train and monitor employees on NCFAST to ensure notifications are appropriately sent by the DSS caseworker.
Show full finding ▾Hide full finding ▴Information on the federal program: Low Income Home Energy Assistance, CFDA 93.568, U.S. Department of Health and Human Services, passed through the N.C Department of Health and Human Services, Division of Social Services. Criteria or specific requirement: Per the North Carolina Low-Income Home Energy Assistance Compliance Supplement and Energy Programs Manual published by the Division of Social Services, households that are denied assistance or that do not receive reasonably prompt assistance must have an opportunity for a hearing. NC FAST policy requires denials to be marked sent to confirm notice delivered. Condition: We noted that in five instances the Denial Notice form DSS-8107 was not marked sent in NC Fast. In one instance, the Approval/Denial notice form DSS-8107 was not completed and reviewed by the County?s DSS caseworker. Context: We sampled 46 of 1,512 total denied applications. We noted the above condition in 6 of the 46 inspected files. Effect: Case files containing a Denial Notice form 8107 that is not sent to applicants results in a risk that the denied or approved applicants are not receiving timely communication or an opportunity for a hearing. Cause: Internal controls were not in place to ensure the Approval/ Denial Notice for DSS 8107 is completed, reviewed and sent in NC FAST. Recommendation: We recommend that the County continue to train and monitor employees on NCFAST to ensure notifications are appropriately sent by the DSS caseworker.
Name of Contact Person: Mia L. Stockton, Economic Services Division Director Summary of Finding: Caseworkers? failure to review the notice generated by NCFAST or failure to mark notice ?sent? within NCFAST to actively show the notice sent. Corrective Action Plan: All approvals receive second party review to ensure the appropriate notice is sent and the NCFAST system is marked ?sent? appropriately. Huddle meeting conducted with staff in August 2019 after the initial audit findings. Energy staff received refresher policy training conducted by Quality/Training Team in October of 2019. Supervisors will meet with staff on an individual level monthly or bi-monthly to review errors/audit findings. Supervisor will hold team meetings to discuss best practices and common trends. Training/Quality Assurance team will facilitate classroom trainings and provide in-service training based on trends identified from the quality audit gradebook for economic services and will conduct any additional trainings arranged by Program Manager or Supervisors. Program Manager will facilitate or arrange classroom training and develop/organize additional in-service training for all staff. Proposed completion date: Implemented August 2019/November 2019, continuous.
FAC accepted this audit on November 29, 2018 — management decision was due May 29, 2019.
GSA_MIGRATION
Show full finding ▾Hide full finding ▴FAC accepted this audit on November 15, 2017 — management decision was due May 15, 2018.
GSA_MIGRATION
Show full finding ▾Hide full finding ▴FAC accepted this audit on November 20, 2016 — management decision was due May 20, 2017.
GSA_MIGRATION
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