U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
CFDA #: 93.778
Finding: 2023-001 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria: "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."
Condition: There were 2 errors discovered during our procedures that inaccurate information was entered when determining eligibility.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: "We examined 60 cases from of a total of 1,034,423 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. "
Effect: 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.
Cause: "Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. "
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. "
Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective Action Plan in the following section.
Finding: 2023-002 Inaccurate Resource Entry
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria: "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."
Condition: There was 1 error 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.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: "We examined 60 cases from of a total of 1,034,423 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. "
Section III. Federal Award Findings and Questioned Costs (continued)
Effect: 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.
Cause: "Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. "
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. "
Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective Action Plan in the following section.
Finding: 2023-003 Inadequate Request For Information
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria: "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. "
Condition: There were 6 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: "We examined 60 cases from of a total of 1,034,423 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. "
Effect: 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.
Cause: "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)
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 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."
Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective Action Plan in the following section.
Finding: 2023-004 Non-cooperation with Child Support Procedures
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria: 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.
Condition: There were 1 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: "We examined 60 cases from of a total of 1,034,423 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. "
Effect: 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.
Cause: Error in reading the ACTS report and/or ineffective case review process.
Recommendation: 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.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective Action Plan in the following section.
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
CFDA #: 93.778
Finding: 2023-001 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria: "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."
Condition: There were 2 errors discovered during our procedures that inaccurate information was entered when determining eligibility.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: "We examined 60 cases from of a total of 1,034,423 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. "
Effect: 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.
Cause: "Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. "
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. "
Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective Action Plan in the following section.
Finding: 2023-002 Inaccurate Resource Entry
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria: "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."
Condition: There was 1 error 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.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: "We examined 60 cases from of a total of 1,034,423 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. "
Section III. Federal Award Findings and Questioned Costs (continued)
Effect: 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.
Cause: "Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. "
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. "
Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective Action Plan in the following section.
Finding: 2023-003 Inadequate Request For Information
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria: "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. "
Condition: There were 6 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: "We examined 60 cases from of a total of 1,034,423 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. "
Effect: 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.
Cause: "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)
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 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."
Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective Action Plan in the following section.
Finding: 2023-004 Non-cooperation with Child Support Procedures
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria: 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.
Condition: There were 1 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: "We examined 60 cases from of a total of 1,034,423 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. "
Effect: 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.
Cause: Error in reading the ACTS report and/or ineffective case review process.
Recommendation: 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.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective Action Plan in the following section.