US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the
Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the
family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial
parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause
for not cooperating must be established when determining Medicaid eligibility.
There were 2 errors discovered during our procedures that referrals between Department of Social Services
(DSS) and Child Support Agencies were not made.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 from a total of 1,870,417 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 North Carolina Families Accessing Services through Technology (NC FAST) and a participant
could have been approved for benefits for which they were not eligible.
Human error in reading the Automated Collection and Tracking System (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 determining 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.
Views of responsible
officials and planned
corrective actions:
Finding: 2023-002 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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.
The County agrees with the finding.
Section III. Federal Award Findings and Questioned Costs (continued)
This is a repeat finding from the immediate previous audit, 2022-003.
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
The County agrees with the finding.
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
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.
There were 9 errors discovered during our procedures that inaccurate information was entered when determining
eligibility.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 from a total of 1,870,417 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.
US Department of Health and Human Services
Section III. Federal Award Findings and Questioned Costs (continued)
The County agrees with the finding.
Program Name: Medical Assistance Program (Medicaid; Title XIX)
Section IV. State Award Findings and Questioned Costs
AL # 93.778
There were 6 errors discovered during our procedures that inadequate information was requested at applications
and/or redeterminations.
For those certifications/re-certifications there was a chance that information was not properly documented and
reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received
assistance for which they were not eligible.
We examined 60 from a total of 1,870,417 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 was no known affect to eligibility and there were no known questioned costs.
AL # 93.778
This is a repeat finding from the immediate previous audit, 2022-005.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
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 and 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.
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
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.
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the
Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the
family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial
parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause
for not cooperating must be established when determining Medicaid eligibility.
There were 2 errors discovered during our procedures that referrals between Department of Social Services
(DSS) and Child Support Agencies were not made.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 from a total of 1,870,417 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 North Carolina Families Accessing Services through Technology (NC FAST) and a participant
could have been approved for benefits for which they were not eligible.
Human error in reading the Automated Collection and Tracking System (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 determining 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.
Views of responsible
officials and planned
corrective actions:
Finding: 2023-002 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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.
The County agrees with the finding.
Section III. Federal Award Findings and Questioned Costs (continued)
This is a repeat finding from the immediate previous audit, 2022-003.
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
The County agrees with the finding.
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
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.
There were 9 errors discovered during our procedures that inaccurate information was entered when determining
eligibility.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 from a total of 1,870,417 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.
US Department of Health and Human Services
Section III. Federal Award Findings and Questioned Costs (continued)
The County agrees with the finding.
Program Name: Medical Assistance Program (Medicaid; Title XIX)
Section IV. State Award Findings and Questioned Costs
AL # 93.778
There were 6 errors discovered during our procedures that inadequate information was requested at applications
and/or redeterminations.
For those certifications/re-certifications there was a chance that information was not properly documented and
reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received
assistance for which they were not eligible.
We examined 60 from a total of 1,870,417 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 was no known affect to eligibility and there were no known questioned costs.
AL # 93.778
This is a repeat finding from the immediate previous audit, 2022-005.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
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 and 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.
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
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.