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)
AL #: 93.778
Finding: 2023-004 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Section II - Financial Statement Findings (continued)
The County agrees with this finding.
In accordance with North Carolina General Statutes SS 143C, budget revisions must be requested and
approved prior to any commitment and/or expenditure that would exceed the amount budgeted. Entities should
not overspend the authorized budget.
The County overspent in Information Technology by $199,505, Court Facilities by $5,908, General and
Administrative by $210,485, Jail by $1,491, and Emergency Services by $29,403. This was an oversight that
resulted from not budgeting for GASB 96 entries. Efforts will be made to ensure that the budget is
appropriately amended in the future.
The Board spent funds that were not available for those respective departments.
The County did not properly amend the budget as needed to account for the GASB 96 entries that were
necessary in the current year.
The budget should be reviewed and appropriate amendments made during the year.
Section III - Federal Award Findings and Questioned Costs
There was no known affect to eligibility and there were no known questioned costs.
There were 7 errors discovered during our procedures that referrals between DSS and Child Support Agencies
were not properly made.
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 noncustodial
parent. Cooperation requirement with Department of Social Services (DSS) and Child Support
Agencies must be met or good cause for not cooperating must be established when determine Medicaid
eligibility.
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.
We examined 60 cases from of a total of 754,993 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.
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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)
AL #: 93.778
Finding: 2023-005 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 754,993 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.
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.
This is a repeat finding from the immediate previous audit, 2022-006.
Section III - Federal Award Findings and Questioned Costs (continued)
The County agrees with the finding. See Corrective Action Plan in the following section.
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 eligibilitydeterminations. 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 5 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
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. See Corrective Action Plan in the following section.
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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)
AL #: 93.778
Finding: 2023-005 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 754,993 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.
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.
This is a repeat finding from the immediate previous audit, 2022-006.
Section III - Federal Award Findings and Questioned Costs (continued)
The County agrees with the finding. See Corrective Action Plan in the following section.
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 eligibilitydeterminations. 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 5 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
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. 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)
AL #: 93.778
Finding: 2023-006 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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)
AL #: 93.778
Finding: 2023-007 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
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.
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. See Corrective Action Plan in the following section.
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 4 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
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.
There were 5 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 known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 754,993 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)
This is a repeat finding from the immediate previous audit, 2022-007.
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)
AL #: 93.778
Finding: 2023-006 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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)
AL #: 93.778
Finding: 2023-007 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
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.
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. See Corrective Action Plan in the following section.
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 4 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
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.
There were 5 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 known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 754,993 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)
This is a repeat finding from the immediate previous audit, 2022-007.
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Food and Nutrition Services (FNS) Cluster
AL # 10.551 and 10.561
Finding: 2023-008 Inaccurate Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
This is a repeat finding from the immediate previous audit, 2022-009.
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
There was no known affect to eligibility and there were no known 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.
Section III - Federal Award Findings and Questioned Costs (continued)
Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective
internal control over the Federal award that provides reasonable assurance that the non-federal entity is
managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of
the Federal award. The State has provided policies and procedures to ensure that the County is meeting the
federal guidance, relevant policies are:
Food and Nutrition Services Policy 305 describes the verification sources and requirements and the FNS units
primary responsibility for providing documentary evidence to support statements on applications and
recertifications and procedures required if the statements by applicant/beneficiary are questionable.
Food and Nutrition Services Policy 300 describes the sources of income countable and not countable to the
household for determining financial eligibility.
Food and Nutrition Services Policy 310 describes the procedures related to verifying changes in income (i.e.
termination, end of contract, temporary, etc.).
We examined 60 cases from of a total of 754,993 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.
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Food and Nutrition Services (FNS) Cluster
AL # 10.551 and 10.561
Finding: 2023-008 Inaccurate Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
This is a repeat finding from the immediate previous audit, 2022-009.
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
There was no known affect to eligibility and there were no known 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.
Section III - Federal Award Findings and Questioned Costs (continued)
Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective
internal control over the Federal award that provides reasonable assurance that the non-federal entity is
managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of
the Federal award. The State has provided policies and procedures to ensure that the County is meeting the
federal guidance, relevant policies are:
Food and Nutrition Services Policy 305 describes the verification sources and requirements and the FNS units
primary responsibility for providing documentary evidence to support statements on applications and
recertifications and procedures required if the statements by applicant/beneficiary are questionable.
Food and Nutrition Services Policy 300 describes the sources of income countable and not countable to the
household for determining financial eligibility.
Food and Nutrition Services Policy 310 describes the procedures related to verifying changes in income (i.e.
termination, end of contract, temporary, etc.).
We examined 60 cases from of a total of 754,993 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.
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
SIGNIFICANT DEFICENCY: Finding 2023-004, 2023-005, 2023-006, 2023-007 also apply to State requirements and State Awards.
Section IV - State Award Findings and Questioned Costs
internal review process is adequately completed to identify and correct errors in case reviews.
The County agrees with the finding and is implementing actions to correct these issues, which are further
discussed in the corrective action plan.
There were a total of 8 errors found in our testing: 4 instances where verification of an expense used for a
deduction of income was not included in the case file; 1 instance where verification check returned a record for
employment but the case worker did not follow-up; 1 instance where a telephonic signature was not
approapriately documented in NCFAST; 1 instance where the caseworked did not appropriately end date old
evidence for an expense deduction in NCFAST; and 1 instance where child support income was not entered
correctly in NCFAST.
There was no known affect to eligibility and there were no known questioned costs.
We examined 25 of 14,829 FNS recipients from the a report of all active FNS beneficiaries provided by
Richmond County's Department of Human Services. The finding is being reported with the financial statement
audit as it relates to FNS 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.
Due to the errors noted, eligibility cannot be sufficiently substantiated and there is a risk that the County could
provide funding and/or benefits to individuals who are not program eligible.
The County should provide training of management and staff on the program's eligibility requirements, proper
case review process, and required verifications for eligibility. Also, the County should ensure that their formal
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)
AL #: 93.778
Finding: 2023-004 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Section II - Financial Statement Findings (continued)
The County agrees with this finding.
In accordance with North Carolina General Statutes SS 143C, budget revisions must be requested and
approved prior to any commitment and/or expenditure that would exceed the amount budgeted. Entities should
not overspend the authorized budget.
The County overspent in Information Technology by $199,505, Court Facilities by $5,908, General and
Administrative by $210,485, Jail by $1,491, and Emergency Services by $29,403. This was an oversight that
resulted from not budgeting for GASB 96 entries. Efforts will be made to ensure that the budget is
appropriately amended in the future.
The Board spent funds that were not available for those respective departments.
The County did not properly amend the budget as needed to account for the GASB 96 entries that were
necessary in the current year.
The budget should be reviewed and appropriate amendments made during the year.
Section III - Federal Award Findings and Questioned Costs
There was no known affect to eligibility and there were no known questioned costs.
There were 7 errors discovered during our procedures that referrals between DSS and Child Support Agencies
were not properly made.
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 noncustodial
parent. Cooperation requirement with Department of Social Services (DSS) and Child Support
Agencies must be met or good cause for not cooperating must be established when determine Medicaid
eligibility.
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.
We examined 60 cases from of a total of 754,993 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.
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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)
AL #: 93.778
Finding: 2023-005 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 754,993 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.
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.
This is a repeat finding from the immediate previous audit, 2022-006.
Section III - Federal Award Findings and Questioned Costs (continued)
The County agrees with the finding. See Corrective Action Plan in the following section.
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 eligibilitydeterminations. 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 5 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
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. See Corrective Action Plan in the following section.
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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)
AL #: 93.778
Finding: 2023-005 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 754,993 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.
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.
This is a repeat finding from the immediate previous audit, 2022-006.
Section III - Federal Award Findings and Questioned Costs (continued)
The County agrees with the finding. See Corrective Action Plan in the following section.
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 eligibilitydeterminations. 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 5 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
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. 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)
AL #: 93.778
Finding: 2023-006 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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)
AL #: 93.778
Finding: 2023-007 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
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.
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. See Corrective Action Plan in the following section.
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 4 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
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.
There were 5 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 known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 754,993 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)
This is a repeat finding from the immediate previous audit, 2022-007.
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)
AL #: 93.778
Finding: 2023-006 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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)
AL #: 93.778
Finding: 2023-007 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
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.
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. See Corrective Action Plan in the following section.
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 4 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
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.
There were 5 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 known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 754,993 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)
This is a repeat finding from the immediate previous audit, 2022-007.
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Food and Nutrition Services (FNS) Cluster
AL # 10.551 and 10.561
Finding: 2023-008 Inaccurate Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
This is a repeat finding from the immediate previous audit, 2022-009.
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
There was no known affect to eligibility and there were no known 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.
Section III - Federal Award Findings and Questioned Costs (continued)
Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective
internal control over the Federal award that provides reasonable assurance that the non-federal entity is
managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of
the Federal award. The State has provided policies and procedures to ensure that the County is meeting the
federal guidance, relevant policies are:
Food and Nutrition Services Policy 305 describes the verification sources and requirements and the FNS units
primary responsibility for providing documentary evidence to support statements on applications and
recertifications and procedures required if the statements by applicant/beneficiary are questionable.
Food and Nutrition Services Policy 300 describes the sources of income countable and not countable to the
household for determining financial eligibility.
Food and Nutrition Services Policy 310 describes the procedures related to verifying changes in income (i.e.
termination, end of contract, temporary, etc.).
We examined 60 cases from of a total of 754,993 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.
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Food and Nutrition Services (FNS) Cluster
AL # 10.551 and 10.561
Finding: 2023-008 Inaccurate Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
This is a repeat finding from the immediate previous audit, 2022-009.
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
There was no known affect to eligibility and there were no known 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.
Section III - Federal Award Findings and Questioned Costs (continued)
Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective
internal control over the Federal award that provides reasonable assurance that the non-federal entity is
managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of
the Federal award. The State has provided policies and procedures to ensure that the County is meeting the
federal guidance, relevant policies are:
Food and Nutrition Services Policy 305 describes the verification sources and requirements and the FNS units
primary responsibility for providing documentary evidence to support statements on applications and
recertifications and procedures required if the statements by applicant/beneficiary are questionable.
Food and Nutrition Services Policy 300 describes the sources of income countable and not countable to the
household for determining financial eligibility.
Food and Nutrition Services Policy 310 describes the procedures related to verifying changes in income (i.e.
termination, end of contract, temporary, etc.).
We examined 60 cases from of a total of 754,993 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.
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
SIGNIFICANT DEFICENCY: Finding 2023-004, 2023-005, 2023-006, 2023-007 also apply to State requirements and State Awards.
Section IV - State Award Findings and Questioned Costs
internal review process is adequately completed to identify and correct errors in case reviews.
The County agrees with the finding and is implementing actions to correct these issues, which are further
discussed in the corrective action plan.
There were a total of 8 errors found in our testing: 4 instances where verification of an expense used for a
deduction of income was not included in the case file; 1 instance where verification check returned a record for
employment but the case worker did not follow-up; 1 instance where a telephonic signature was not
approapriately documented in NCFAST; 1 instance where the caseworked did not appropriately end date old
evidence for an expense deduction in NCFAST; and 1 instance where child support income was not entered
correctly in NCFAST.
There was no known affect to eligibility and there were no known questioned costs.
We examined 25 of 14,829 FNS recipients from the a report of all active FNS beneficiaries provided by
Richmond County's Department of Human Services. The finding is being reported with the financial statement
audit as it relates to FNS 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.
Due to the errors noted, eligibility cannot be sufficiently substantiated and there is a risk that the County could
provide funding and/or benefits to individuals who are not program eligible.
The County should provide training of management and staff on the program's eligibility requirements, proper
case review process, and required verifications for eligibility. Also, the County should ensure that their formal