Federal Reports

The North Carolina Division of Medical Assistance (State agency) did not always use the correct Federal medical assistance percentages (FMAPs) when processing claim adjustments reported to the Centers for Medicare & Medicaid Services. Of the 9.2 million claims we reviewed, the State agency processed 1.9 million claims using incorrect FMAPs resulting in no impact. However, the remaining 7.3 million claims were paid using incorrect FMAPs resulting in a net overpayment. As a result, the State agency received $1.6 million (Federal share) more in Federal reimbursement than it was entitled to. These errors occurred because the State agency did not have adequate internal controls to process claim adjustments in accordance with Federal requirements.

Although the Florida Department of Children and Families (State licensing agency) or county conducted the required inspections at the four providers that we reviewed, this onsite monitoring did not ensure that providers that received funds from the Child Care and Development Fund complied with State licensing requirements related to the health and safety of children. Although one provider complied with staff and child record requirements, all four of the providers that we visited did not comply with the physical conditions requirements, two providers did not comply with staff record requirements, and two providers did not comply with child record requirements.

The Florida Office of Early Learning (State lead agency) or counties did not always ensure that providers that received funding from the Child Care and Development Fund (CCDF) complied with State requirements related to the health and safety of children. Specifically, of the 20 providers we selected for review, 15 did not comply with 1 or more of the physical conditions requirements; 11 did not comply with child record requirements; 4 did not comply with staff documentation requirements; and 4 were not available during operating hours to complete our unannounced inspection, which prevented us from assessing the physical conditions and children's records within these providers related to the health and safety of children in their care.

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By not following Federal Acquisition Regulation requirements, the CSB’s $125,000 Vantage contract was at risk for mismanagement.