1. Keeping History From Repeating Itself:
Maryland’s AuditTask Force
APHSA NAPIPM Conference
Savannah, Georgia
August 2015
Presented by:
Vesta Kimble, Deputy Executive Director
Family Investment Administration
Maryland Department of Human Resources

2. “Those who cannot remember the past
are condemned to repeat it.”
--George Santayana,
philosopher, poet and novelist
The Life of Reason, 1906

3.  24 Local Departments of Social Services; 47
physical offices
 Largest five departments account for about 75-80%
of the cases.
 Bordered by: Pennsylvania, District of Columbia,
WestVirginia,Virginia and Delaware

4.  Medicaid: 408,000
 Food Supplement Program (SNAP): 404,000
 Temporary Cash Assistance: 24,000
 Temporary Disability Assistance Program: 18,500
 LongTerm Care Medicaid: 16,500
 Emergency Assistance: 10,800
 Public Assistance for Adults: 3,600
 Burial Assistance: 245

5.  The Office of Inspector General is part of our
department
 Conducts fraud investigations
 Generates data matches (death, lottery, etc.)
 Conducts annual audits of all local offices
 The Office of Legislative Audits (part of the
Maryland legislature)
 Conducts audits of DHR headquarters
 Certifies OIG audits of local offices

6.  Federal Reviews and Audits:
 USDA Food & Nutrition Service for SNAP:
• Program integrity reviews
• Program access reviews
• Management evaluation reviews
• Employment and training reviews
• Fiscal management
• Statistical audit
• Civil rights reviews
• Payment accuracy reviews

7.  Federal Reviews and Audits (continued):
 Department of Health & Human Services:
▪ Office of Civil Rights audit
▪ Office of Refugee Resettlement audit
▪ Single State Audit (forTANF, Child Support, IEVS)
 Centers for Medicare & Medicaid Services
▪ PERM reviews of Medical Assistance cases

8.  Federal Reviews and Audits (continued):
 Internal Revenue Service
▪ Safeguards Review for tax information
 Social Security Administration
▪ Interim Reimbursement Assistance Review
▪ Data Protection Review

9.  Recommendations from auditors in audit reports
are vague and not helpful “We recommend that
the agency perform the [task/metric.]”
 Responses we write to the Audits and Reviews are
often disjointed, reactive and routine.
 Systemic changes are seldom considered in
corrective action plans.
 Repeat findings stack up year after year.

10.  Track corrective measures for audits and
federal reviews. (We will nag.)
 Develop innovative and systemic changes that
are realistic, timely and cost-efficient.
 Prevent repeat audit findings.
 Create a snapshot of data for leadership to
know where we are always with our audit
findings and responses.

11.  Local Offices with high # of findings
 Bureau of Quality Control
 Bureau of Local Operations
 Bureau of Program Evaluation
 Bureau of LongTerm Care
 Bureau of InformationAnalysis
 Bureau of Policy, Research andTraining
 Bureau of Systems Support & Development
 Maryland Office of Refugees and Asylees
 Bureau of Special Grants
 Bureau ofWorkforce Development
 Office of Home Energy Program
 Office of Inspector General Yep! That’s right, the auditors!

12.  Schedule monthlyTask Force meetings (no longer
than 1.5 hours)
 Review progress on action items for specific reviews
and findings.
 Add upcoming reviews and audits to the list of those to
monitor
 Schedule “Deep Dive” sessions – one per month –
on specific topics
 Invite those who need to be around the table
 As well as allTask Force members who want to attend
 Develop specific tasks for resolving audit findings

13.  List ofTask Force meetings
 List of “Deep Dive” sessions
 April 29 (Missing SSNs)
 June 22 (SNAP Employment &Training)
 July 22 (Interim Reimbursement Agreements)
 August (Electronic Benefit TransferVault Cards)
 April 27
 May 14
 June 17
 July 21
 August 20

14.  Legislative Audit for 2010 – 2013 finding:
10,500 cases without a Social Security
Number
 When an SSN is missing, the case manager
must request the number from the head of
the household.
 Newborns often are added to cases without
SSNs.
 Public perception
No Social Security Number  Fraud

16.  W
 H
 F
Smartsheet allows you to
share the work, set
expectations for tasks, track
actions, schedule and send
emails for updates, and
attach documents.

17.  W
 H
 F

18.  W
 H
 F

19.  W
 H
 F

20.  Automated tool to deliver cases that are
missing SSN to local offices
 Track actions in tool from Central Office
 Report progress to the local offices

22. State of Maryland
Department of Human Resources
Date:
KRISTEN DELVEPHILLIPS
1509 LODGE POLE CT
ANNAPOLIS MD 21409
Type of
case: Food Supplement
Client ID:
.
448050487
Name of individual with
missing SSN:
8/25/2015
Please write in the SSN nextto the name above. You can bring this letter to your local DSS
office or send itback. Please respond no later than
Ifwe do notreceive the SSN, the individual listed above may be removed from your case, which
may affectyour benefits or your case may close. Ifchanges are going to be made to your
benefits because have you notprovided the needed SSN, you will receive separate notice
Thank you for providing this information.
State and Federal laws require thateach person receiving assistance (Food Supplement, Cash
Assistance, or Medical Assistance) have a Social Security Number (SSN) in our system. We
reviewed your case file and cannotlocate an SSN for the individual listed below, or the SSN
number thatwe have on file for the individual is incorrect:
You are receiving this letter because you need to provide us with information for your
DepartmentofSocial Services case.
NOAH PHILLIPS
PARIYAR
Maryland’s Human Services Agency
Client ID#:
NOTICE OF MISSING SOCIAL SECURITY NUMBER
YOUR LOCAL OFFICE:
ANNAPOLIS
8/11/2015 440031150

24. 12,326
8,872
4,915 4,890
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Social Services 60% decrease Health Dept. 45% decrease
Recipients without Social Security Numbers
Local Social Services Offices vs. Local Health Dept. Offices
Apr 2015 Aug 2015

25. % Reduction in Missing SSNs, by DSS Office
Local Office 80 140 220 110 60 300 50 190
% reduction 90% 84% 73% 73% 71% 66% 64% 63%
Local Office 210 40 70 200 160 180 20 90
% reduction 60% 57% 56% 55% 54% 53% 50% 47%
Local Office 10 30 120 150 130 170
% reduction 46% 41% 41% 38% 26% 20%

26. Comparing Offices Relative to their Caseloads
Missing SSN LDSS Caseload Analysis
Local
Department of
Social Serices
Total #
Missing SSNs
% of
Statewide
Missing SSNs
% of Caseload
Missing SSNs
130 229 4.9% 2.4%
30 1,078 23.2% 1.9%
100 177 3.8% 1.7%
150 645 13.9% 1.7%
230 64 1.4% 1.7%

27.  Interim Reimbursement Agreements
 Need to collect funds paid to those cash
assistance recipients once Federal disability
(SSI) is awarded
 # of local departments with findings
▪ Local finance office not coordinating with the local
caseload units
 Best answer: centralize the function and
conduct case reviews centrally

28.  What strategies do you have to reduce your
repeat findings?

29. Vesta Kimble
Deputy Executive Director
Family Investment Administration
Maryland Department of Human Resources
vesta.kimble@maryland.gov