US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-001 Inaccurate Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Section I - Summary of Auditors' Results (continued)
There were 3 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
This is a repeat finding from the immediate previous audit, 2022-001.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 896,867 Medicaid claims from the Medicaid beneficiary report
provided by NC Department of Health and Human Services to re-determine eligibility. These findings are
being reported with the financial statement audit as it relates to Medicaid administrative cost compliance
audit.
For those certifications/re-certifications there was a chance that information was not properly documented
and reconciled to NC FAST and a participant could have been approved for benefits for which they were
not eligible.
Section III - Federal Award Findings and Questioned Costs
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient
meets specific standards, and documentation must be maintained to support eligibility determinations. In
accordance with 2 CFR 200, management should have an adequate system of internal controls procedures
in place to ensure an applicant is properly determined or redetermined for benefits.
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2023-002 Inaccurate Resource Calculation
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income and
those amounts agree to information in NC FAST. The results found or documentation made in case notes
should clearly indicate what actions were performed and the results of those actions.
In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records
should contain documentation that verifications were done in preparation of the application and these
items will agree to reports in the NC FAST system. In this process, the countable resources should be
calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the
verification process should be considered countable or non-countable resources and explained within the
documentation.
The County agrees with the finding. See Corrective Action Plan in the following section.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2023-002 Inaccurate Resource Calculation
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income and
those amounts agree to information in NC FAST. The results found or documentation made in case notes
should clearly indicate what actions were performed and the results of those actions.
In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records
should contain documentation that verifications were done in preparation of the application and these
items will agree to reports in the NC FAST system. In this process, the countable resources should be
calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the
verification process should be considered countable or non-countable resources and explained within the
documentation.
The County agrees with the finding. See Corrective Action Plan in the following section.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Section III - Federal Award Findings and Questioned Costs (Continued)
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income and
those amounts agree to information in NC FAST. The results found or documentation made in case notes
should clearly indicate what actions were performed and the results of those actions.
There were 7 errors discovered during our procedures that resources in the county documentation and
those same resources contained in NC FAST were not the same amounts or files containing resources
were not properly documented to be considered countable or non-countable.
There was no affect to eligibility and there were no questioned costs.
We examined 60 cases from of a total of 896,867 Medicaid claims from the Medicaid beneficiary report
provided by NC Department of Health and Human Services to re-determine eligibility. These findings are
being reported with the financial statement audit as it relates to Medicaid administrative cost compliance
audit.
For those certifications/re-certifications there was a chance that information was not properly documented
and reconciled to NC FAST and a participant could have been approved for benefits for which they were
not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
This is a repeat finding from the immediate previous audit, 2022-002.
The County agrees with the finding. See Corrective Action Plan in the following section.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2023-003 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
None reported.
Section V - Passenger Facility Charge Program Findings and Questioned Costs
For those certifications/re-certifications there was a chance that information was not properly documented
and reconciled to NC FAST and applicants could have been approved for benefits for which they were
not eligible.
Error in reading the ACTS report and/or ineffective case review process.
Files should be reviewed internally to ensure proper information is in place and necessary procedures are
taken when determine eligibility. The results found or documentation made in case notes should clearly
indicate what actions were performed and the results of those actions.
The County agrees with the finding. See Corrective Action Plan in the following section.
This is a repeat finding from the immediate previous audit, 2022-004.
We examined 60 cases from of a total of 896,867 Medicaid claims from the Medicaid beneficiary report
provided by NC Department of Health and Human Services to re-determine eligibility. These findings are
being reported with the financial statement audit as it relates to Medicaid administrative cost compliance
audit.
There were no known affects to eligibility and there were no known questioned costs.
Section III - Federal Award Findings and Questioned Costs (Continued)
SIGNIFICANT DEFICENCY: Finding 2023-001, 2023-002, and 2023-003 also apply to State requirements and State Awards.
The County agrees with the finding. See Corrective Action Plan in the following section.
Section IV - State Award Findings and Questioned Costs
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient
meets specific standards, and documentation must be maintained to support eligibility determinations.
Electronic matches are required at applications and redeterminations.
There were 3 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-001 Inaccurate Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Section I - Summary of Auditors' Results (continued)
There were 3 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
This is a repeat finding from the immediate previous audit, 2022-001.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 896,867 Medicaid claims from the Medicaid beneficiary report
provided by NC Department of Health and Human Services to re-determine eligibility. These findings are
being reported with the financial statement audit as it relates to Medicaid administrative cost compliance
audit.
For those certifications/re-certifications there was a chance that information was not properly documented
and reconciled to NC FAST and a participant could have been approved for benefits for which they were
not eligible.
Section III - Federal Award Findings and Questioned Costs
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient
meets specific standards, and documentation must be maintained to support eligibility determinations. In
accordance with 2 CFR 200, management should have an adequate system of internal controls procedures
in place to ensure an applicant is properly determined or redetermined for benefits.
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2023-002 Inaccurate Resource Calculation
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income and
those amounts agree to information in NC FAST. The results found or documentation made in case notes
should clearly indicate what actions were performed and the results of those actions.
In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records
should contain documentation that verifications were done in preparation of the application and these
items will agree to reports in the NC FAST system. In this process, the countable resources should be
calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the
verification process should be considered countable or non-countable resources and explained within the
documentation.
The County agrees with the finding. See Corrective Action Plan in the following section.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2023-002 Inaccurate Resource Calculation
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income and
those amounts agree to information in NC FAST. The results found or documentation made in case notes
should clearly indicate what actions were performed and the results of those actions.
In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled case records
should contain documentation that verifications were done in preparation of the application and these
items will agree to reports in the NC FAST system. In this process, the countable resources should be
calculated correctly and agree back to the amounts in the NC FAST system. Any items discovered in the
verification process should be considered countable or non-countable resources and explained within the
documentation.
The County agrees with the finding. See Corrective Action Plan in the following section.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Section III - Federal Award Findings and Questioned Costs (Continued)
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income and
those amounts agree to information in NC FAST. The results found or documentation made in case notes
should clearly indicate what actions were performed and the results of those actions.
There were 7 errors discovered during our procedures that resources in the county documentation and
those same resources contained in NC FAST were not the same amounts or files containing resources
were not properly documented to be considered countable or non-countable.
There was no affect to eligibility and there were no questioned costs.
We examined 60 cases from of a total of 896,867 Medicaid claims from the Medicaid beneficiary report
provided by NC Department of Health and Human Services to re-determine eligibility. These findings are
being reported with the financial statement audit as it relates to Medicaid administrative cost compliance
audit.
For those certifications/re-certifications there was a chance that information was not properly documented
and reconciled to NC FAST and a participant could have been approved for benefits for which they were
not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
This is a repeat finding from the immediate previous audit, 2022-002.
The County agrees with the finding. See Corrective Action Plan in the following section.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2023-003 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
None reported.
Section V - Passenger Facility Charge Program Findings and Questioned Costs
For those certifications/re-certifications there was a chance that information was not properly documented
and reconciled to NC FAST and applicants could have been approved for benefits for which they were
not eligible.
Error in reading the ACTS report and/or ineffective case review process.
Files should be reviewed internally to ensure proper information is in place and necessary procedures are
taken when determine eligibility. The results found or documentation made in case notes should clearly
indicate what actions were performed and the results of those actions.
The County agrees with the finding. See Corrective Action Plan in the following section.
This is a repeat finding from the immediate previous audit, 2022-004.
We examined 60 cases from of a total of 896,867 Medicaid claims from the Medicaid beneficiary report
provided by NC Department of Health and Human Services to re-determine eligibility. These findings are
being reported with the financial statement audit as it relates to Medicaid administrative cost compliance
audit.
There were no known affects to eligibility and there were no known questioned costs.
Section III - Federal Award Findings and Questioned Costs (Continued)
SIGNIFICANT DEFICENCY: Finding 2023-001, 2023-002, and 2023-003 also apply to State requirements and State Awards.
The County agrees with the finding. See Corrective Action Plan in the following section.
Section IV - State Award Findings and Questioned Costs
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient
meets specific standards, and documentation must be maintained to support eligibility determinations.
Electronic matches are required at applications and redeterminations.
There were 3 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.