Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart A - Assistance Policies and Procedures › Chapter 109 - AUDITS › Section 109.3 - Requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
The
				  audit review of public assistance cases.
The auditors will provide the
				  county office with a list of the case records to be included in the audit. The
				  county will provide these records within 24 hours. Requests for the return of
				  certain cases needed for County Office business may be worked out amicably with
				  the auditors. Audits will be conducted on a planned, scheduled basis by
				  auditors of the Bureau of Public Assistance Audits, Department of the Auditor
				  General. The audit of the Public Assistance file will be made from a sampling
				  of Aid to Dependent Children, General Assistance, Food Stamp, Medical
				  Assistance and State Blind Pension case records. The audit will be conducted in
				  three progressive phases.
(1)
Record
				  information, Phase I.
The record information phase is an audit of each
				  case record of the sample for accuracy and propriety of cash grants being paid,
				  food stamps being issued and Medical Assistance being granted. The attention of
				  the auditor will be focused on the case record material as it relates to the
				  proper interpretation and application of the rules and regulations of the
				  Department pertaining to the recipient's eligibility for Public Assistance,
				  Food Stamps or Medical Assistance.
(2)
Field visit, Phase II.
The field visit phase is that period of the audit during which the auditors
				  visit a selected number of the recipients whose case record was audited in the
				  record information phase. The field visit auditor may contact collateral
				  resources as they pertain to the particular recipient whose case record is
				  being audited. The purpose of the field visit audit is to substantiate the
				  particular case record information and to obtain any other information
				  pertaining to the eligibility of the particular recipient, for public
				  assistance. The field visit audit will be conducted in a confidential, tactful,
				  and respectful manner.
(3)
Corrective action, Phase III.
The corrective action phase is
				  that period of the audit during which the county staff takes action on the
				  exceptions which the auditors indicated. The auditors will take exceptions
				  based upon misapplication by the county office of the rules and regulations of
				  the Department. The auditor will also take exceptions when the auditor
				  discovers information affecting eligibility which is not known to the county
				  office. Exceptions will be based on the following:
(i) The data in the case records as of the
				  date it is reviewed.
(ii) Data
				  affecting eligibility that is not in the case record at the time the case is
				  requested.
(iii) The information
				  obtained at the interview.
(iv) The
				  information obtained from documents examined.
(v) Information from sources other than the
				  client.
(4)
Determination made during the review.
The determination made
				  during the review will be based on the following:
(i) The accuracy and propriety of the cash
				  grants, food stamps or medical assistance being provided. This includes
				  substantiating that the case record supports the amount being paid.
(ii) Whether regulations and procedures
				  regarding overpayment, restitution and reimbursement have been
				  followed.
(iii) Whether required
				  record documentation is complete, including signed applications, reimbursement
				  agreements and other appropriate documents.