YELLOW SHEET
Office of the State Auditor of Missouri
Claire McCaskill
|
|
YELLOW SHEET Office of the State Auditor of Missouri |
Report No. 2005-18
March 2005
The United States Congress passed the Single Audit Act of 1996 to establish uniform requirements for audits of federal awards administered by states, local governments, and non-profit organizations. The Single Audit includes the federal awards expended by all state agencies, except for the public universities and various financing authorities which provide their financial information directly to the federal government. State agencies expended $8.3 billion of federal grant funds during the year ended June 30, 2004. Expenditures of federal awards have increased significantly over the past five years. Although all sixteen state departments and other state offices expended federal awards, six state departments expended the bulk of the federal awards (94 percent). These six departments are: Social Services, Transportation, Labor and Industrial Relations, Elementary and Secondary Education, Health and Senior Services, and Office of Administration. Overall, the state expended federal awards in 313 different programs.
The state of Missouri did not comply with requirements regarding eligibility that are applicable to its State Children�s Insurance and Medical Assistance programs. Compliance with such requirements is necessary, in the opinion of the State Auditor, for the state of Missouri to comply with the requirements applicable to that program. On April 27, 2004, the Missouri State Auditor's Office issued audit report No. 2004-29, Department of Social Services Medicaid Eligibility. We found Family Support Division (FSD) caseworkers were not performing annual eligibility redeterminations as required by federal and state regulations. As of June 30, 2003, the FSD had not redetermined eligibility within a year or more for 383,004 of 934,453 recipients (41 percent). We question costs totaling $767,270 for Medicaid and $174,693 for SCHIP.
We also noted matters involving the internal control over compliance that we consider to be reportable and material problems.
The current loan servicer used in the Federal Family Education Loan Program has not established procedures to provide that collections are adequately secured and that all collections are fully reconciled to the accounting system and tracked. The loan servicer also has not established an adequate quality control review process regarding paid claims. Required federal reports appear to be inaccurate and lack adequate supporting documentation.
The State Emergency Management Agency has not established adequate internal controls to ensure subrecipient monitoring is properly performed.
Eligibility and payment documentation could not be located for some Department of Social Services (DSS)-Children's Division (CD) Foster Care Title IV-E cases reviewed. We reviewed eligibility documentation for 60 Foster Care benefit recipients. Their Foster Care assistance totaled $205,579 during the year ending June 30, 2004. We could not locate invoices or other adequate supporting documentation for some payments on 62 percent of cases reviewed. We questioned costs of $6,857. A similar condition was also noted in our prior report. In addition, the CD does not verify that residential facility and day care contractors paid more than $25,000 are not suspended or debarred from participating in federal government programs.
On January 13, 2004, the Missouri State Auditor's Office issued audit report No. 2004-01, Oversight Controls and Management in the State's Managed Care Program. Officials with the Division of Medical Services (DMS) cannot measure the utilization of covered services provided to managed care recipients and do not know if the state's total cost truly measured healthcare costs. Additionally, the DMS did not profile the managed care population to determine if capitation payments were made for potentially ineligible recipients, or if the absence of encounter claim records was an indication of problems with access to medical services. Also, fraud detection activities were not performed in the managed care program even though required by federal Medicaid rules.
The DSS-CD made Adoption Assistance payments exceeding contract limits. Also, invoice or other supporting documentation for some payments could not be located. We questioned costs of $12,112. Similar conditions were also noted in our two prior reports.
Also included in the single audit report are recommendations related to subrecipient monitoring in the Department of Mental Health and the Department of Health and Senior Services. Recommendations regarding the Vocational Rehabilitation program, interest calculation errors, and managed care program complaint and grievance reports are also included.