Audit of North Dakota's largest state agency yields mixed results

A new two-year audit of North Dakota's Department of Human Services found several irregularities related to child services and determined some recommendations from a 2017 audit have not yet been implemented.

Human Services Chief Financial Officer Arnie Strebe told the Tribune the agency has taken numerous steps to improve its performance.

State Auditor Josh Gallion released the audit results of North Dakota's largest state agency on Friday. Findings and department responses include:

• As much as $108,425 in Medicaid payments over a five-year period were incorrectly made after people's deaths. The department acknowledged errors in its data but puts the figure at closer to $14,244.
• The department didn't properly reinspect about 25% of correction orders to ensure compliance from child care providers. The department has created a tracking spreadsheet and plans to create a policy for it and a monthly review process.
• The department isn't properly monitoring child care providers operating under a memorandum of understanding due to past noncompliance or facility issues. The MOUs are being phased out, according to the department, which may now issue a provisional or restricted license and require a compliance plan from a provider.
• Delayed assignments of county social service workers led to untimely face-to-face contact with some suspected child abuse and neglect victims. The department said a redesign of child protective services is underway that will provide more timely contact through a restructured practice model.
• The department wasn't completing quality assurance reviews of child abuse and neglect assessments. The department said reviews will be improved through a new quality assurance unit, a checklist and training for human service zone workers.
• Fifty-five confirmed child abusers weren't indexed for background checks for employment and licensing for positions that work with children. The department said index entries were previously made manually but are now automatically posted.
• The department reported incorrect financial information for North Dakota's comprehensive annual fiscal report -- something that ultimately was corrected. The department attributed the errors to recent turnover and is working through new processes for reporting financial information.
• Internal controls aren't sufficient for the Medicaid drug rebate program, leading to potential for fraud and errors. The department is working with the program's system developer for better controls.

"We need to do everything we can to ensure the safety and well being of our most precious resource, our children,” Gallion said in a statement. “The fact that some of these are repetitive findings, meaning we continue to point them out to the agency, and they are not being addressed, is concerning."

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