Medicaid office audit uncovered deficiencies

An audit of the American Samoa Medicaid State Agency for three fiscal years (FY) ending September 30, 2022, uncovered deficiencies in internal controls.

Medicaid is an Agency State Plan for American Samoa developed in 1985 and is to provide policy guidance to help Agency achieve measurable improvement in health outcomes, sustainable cost control, and promote a more efficient administration.

This is the first audit conducted since the establishment and primarily focused on the assessment of management controls supporting the implementation of Agency functions. The Audit Office found several weaknesses in internal controls.

There were key aspects of governing legislation that have not been observed by the Agency such as the appointment of an Agency coordinating council whose responsibilities ensure that the Agency is in compliance with relevant laws and rules and is committed to achieving the State Agency Plan.

According to the audit report, there were deficiencies in internal controls regarding the use of direct payment vouchers for procuring capital items during COVID-19, instances where the payment process such as an invoice was altered manually and other instances where statements, estimations were used instead of originals and authentic invoices.

Also, the Auditors noted weaknesses in internal controls for managing and safeguarding assets whereas the Agency did not maintain an internal asset register to record the details including the location of all assets purchased and entrusted to the Agency.

Furthermore, the Agency did not reconcile its asset inventory against the listing on One Solution. Lastly, the Agency did not have proper documentation to support the transfer of assets to ASG employees both within the Agency and outside the Agency.

In the administration of personnel costs, the Auditors noted the underutilization of the biometric clock-in the system and the absence of a payroll reconciliation of payroll internal records with the payroll disbursed by the Treasury and DHR.

For the administration of leave, Auditors found minor discrepancies with the leave forms where some were not properly filled out and securely filed.

They conclude that the effectiveness of management controls around the Agency's purchases, human resource management, payroll and fixed assets requires improvement.

In saying that, the Agency agrees that there is further work required to ensure the effective and efficient implementation of the Agency's support activities.

While a number of the Agency’s processes adhered to ASG laws and policies, they noted deviations that require the Agency's attention.