US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
In accordance with the Single Audit Act of 1984 (amended in 1996), and the Office of
Management and Budget (OMB) Title 2 U.S. Code of Federal Regulations (CFR) Part 200,
Uniform Administrative Requirements for Federal Awards (Uniform Guidance), a single
audit reporting package and data collection form is required to submitted to the Federal
Audit Clearinghouse (FAC) 30 days after receipt of the auditor's report, or 9 months after
the end of the fiscal year, whichever comes first.
The audit report was not finalized until 10 months after year end.
Federal agencies that provide funding and other public associations need current financial
information about each unit of local government.
The County's audits have been submitted late over the past several years. The County was
unable to provide information necessary to complete the audit timely as a result of staffing
issues.
The County should allocate sufficient resources to ensure that all records are reconciled
timely to allow time for the audit to be completed timely.
There was no known affect to eligibility and there were no known questioned costs.
Section III - Federal Award Findings and Questioned Costs
Program Names: Medical Assistance
AL # 93.778
Finding: 2023-005 Inadequate Request for Information
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 8 errors discovered during our procedures that inadequate information was
requested at applications and/or redeterminations.
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Finding: 2023-006
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-006.
Section III - Federal Award Findings and Questioned Costs (continued)
Views of Responsible
Officials and Planned
Corrective Actions:
The county agrees with this finding. See corrective action plan.
Program Names: Medical Assistance
AL # 93.778
IV-D Non-Cooperation
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.
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 applicants could have been approved for benefits for
which they were not eligible.
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit
as it relates to Medicaid administrative cost compliance audit.
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.
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
There were 2 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.
127
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Finding: 2023-006
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-006.
Section III - Federal Award Findings and Questioned Costs (continued)
Views of Responsible
Officials and Planned
Corrective Actions:
The county agrees with this finding. See corrective action plan.
Program Names: Medical Assistance
AL # 93.778
IV-D Non-Cooperation
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.
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 applicants could have been approved for benefits for
which they were not eligible.
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit
as it relates to Medicaid administrative cost compliance audit.
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.
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
There were 2 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.
127
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Finding: 2023-007
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Context:
AL # 93.778
Inaccurate Information Entry
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if
a recipient meets specific income 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 8 errors discovered during our procedures that inaccurate information was
entered when determining eligibility. One applicant received assistance although the family
income were above the State provided income Standard.
There was no known affect to Questioned Costs: eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit
as it relates to Medicaid administrative cost compliance audit.
Recommendation: 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.
Section III - Federal Award Findings and Questioned Costs (continued)
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
Program Names: Medical Assistance
Views of Responsible
Officials and Planned
Corrective Actions:
The County agrees with the finding. See corrective action plan.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-007.
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Finding: 2023-007
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Context:
AL # 93.778
Inaccurate Information Entry
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if
a recipient meets specific income 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 8 errors discovered during our procedures that inaccurate information was
entered when determining eligibility. One applicant received assistance although the family
income were above the State provided income Standard.
There was no known affect to Questioned Costs: eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit
as it relates to Medicaid administrative cost compliance audit.
Recommendation: 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.
Section III - Federal Award Findings and Questioned Costs (continued)
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
Program Names: Medical Assistance
Views of Responsible
Officials and Planned
Corrective Actions:
The County agrees with the finding. See corrective action plan.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-007.
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
AL # 93.778
Finding: 2023-008
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
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 that clearly indicates
what actions were performed and the results of those actions.
The County agrees with the finding. See corrective action plan.
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, a participant could have been approved to receive benefits for which they were
not eligible.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-008.
Program Names: Medical Assistance
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 noncountable resources and explained within the
documentation.
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. Of these, one beneficiary received assistance for which the
recipient was not eligible.
Views of Responsible
Officials and Planned
Corrective Actions:
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
Inaccurate Resource Calculation
Questioned Costs: The total questioned costs for the ineligibility error noted above did not meet the minimum
threshold for reporting.
Section III - Federal Award Findings and Questioned Costs (continued)
129
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
AL # 93.778
Finding: 2023-008
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
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 that clearly indicates
what actions were performed and the results of those actions.
The County agrees with the finding. See corrective action plan.
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, a participant could have been approved to receive benefits for which they were
not eligible.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-008.
Program Names: Medical Assistance
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 noncountable resources and explained within the
documentation.
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. Of these, one beneficiary received assistance for which the
recipient was not eligible.
Views of Responsible
Officials and Planned
Corrective Actions:
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
Inaccurate Resource Calculation
Questioned Costs: The total questioned costs for the ineligibility error noted above did not meet the minimum
threshold for reporting.
Section III - Federal Award Findings and Questioned Costs (continued)
129
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
AL # 93.778
Finding: 2023-009
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Program Names: Medical Assistance
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
In accordance with the Medicaid Manual MA-3120, the State sends notification to the
County when a participant is no longer eligible under Supplemental Security Income (SSI)
determination, the County is required to initiate the ex parte review within 5 workdays of
the date the termination appears on the SSI Termination Report, and complete the
redetermination within 4 months of the month the case appears on the SSI Termination
Report and notify the recipient about applicant's ongoing eligibility for Medicaid.
There was 2 applicant/beneficiary not reviewed timely and determined to be eligible for
Medicaid when their SSI benefits were terminated, for which the recipient was not eligible.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-009.
Untimely Review of SSI Terminations
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
AL # 93.778
Finding: 2023-009
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Program Names: Medical Assistance
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
In accordance with the Medicaid Manual MA-3120, the State sends notification to the
County when a participant is no longer eligible under Supplemental Security Income (SSI)
determination, the County is required to initiate the ex parte review within 5 workdays of
the date the termination appears on the SSI Termination Report, and complete the
redetermination within 4 months of the month the case appears on the SSI Termination
Report and notify the recipient about applicant's ongoing eligibility for Medicaid.
There was 2 applicant/beneficiary not reviewed timely and determined to be eligible for
Medicaid when their SSI benefits were terminated, for which the recipient was not eligible.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-009.
Untimely Review of SSI Terminations
Context:
Effect:
Cause:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
Section III - Federal Award Findings and Questioned Costs (continued)
Views of Responsible
Officials and Planned
Corrective Actions:
The County agrees with the finding. See corrective action plan.
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit
as it relates to Medicaid administrative cost compliance audit.
The County did not initiate ex parte review timely, therefore, no eligibility review was
completed in the required time period. The lack of follow up and certification lead to
applicants receiving Medicaid benefits for which they were not eligible.
Ineffective communication between departments within the Department of Social Services.
One area within DSS received State communications that applicants would no longer be
eligible for SSI benefits and the County needed to conduct an application process. This
information was not shared with other departments in DSS from which the recipient was
also receiving benefits.
Recommendation: Any State communications related to applicants’ benefits received by any DSS department
should be shared with all areas from which the participant receives benefits. State files
should be reviewed internally to ensure all actions have been properly closed and the
corrective action has been taken. Workers should be retrained on what process needs to be
followed when State communications are received.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-010.
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
In accordance with the Single Audit Act of 1984 (amended in 1996), and the Office of
Management and Budget (OMB) Title 2 U.S. Code of Federal Regulations (CFR) Part 200,
Uniform Administrative Requirements for Federal Awards (Uniform Guidance), a single
audit reporting package and data collection form is required to submitted to the Federal
Audit Clearinghouse (FAC) 30 days after receipt of the auditor's report, or 9 months after
the end of the fiscal year, whichever comes first.
The audit report was not finalized until 10 months after year end.
Federal agencies that provide funding and other public associations need current financial
information about each unit of local government.
The County's audits have been submitted late over the past several years. The County was
unable to provide information necessary to complete the audit timely as a result of staffing
issues.
The County should allocate sufficient resources to ensure that all records are reconciled
timely to allow time for the audit to be completed timely.
There was no known affect to eligibility and there were no known questioned costs.
Section III - Federal Award Findings and Questioned Costs
Program Names: Medical Assistance
AL # 93.778
Finding: 2023-005 Inadequate Request for Information
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 8 errors discovered during our procedures that inadequate information was
requested at applications and/or redeterminations.
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Finding: 2023-006
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-006.
Section III - Federal Award Findings and Questioned Costs (continued)
Views of Responsible
Officials and Planned
Corrective Actions:
The county agrees with this finding. See corrective action plan.
Program Names: Medical Assistance
AL # 93.778
IV-D Non-Cooperation
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.
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 applicants could have been approved for benefits for
which they were not eligible.
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit
as it relates to Medicaid administrative cost compliance audit.
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.
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
There were 2 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.
127
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Finding: 2023-006
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-006.
Section III - Federal Award Findings and Questioned Costs (continued)
Views of Responsible
Officials and Planned
Corrective Actions:
The county agrees with this finding. See corrective action plan.
Program Names: Medical Assistance
AL # 93.778
IV-D Non-Cooperation
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.
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 applicants could have been approved for benefits for
which they were not eligible.
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit
as it relates to Medicaid administrative cost compliance audit.
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.
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
There were 2 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.
127
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Finding: 2023-007
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Context:
AL # 93.778
Inaccurate Information Entry
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if
a recipient meets specific income 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 8 errors discovered during our procedures that inaccurate information was
entered when determining eligibility. One applicant received assistance although the family
income were above the State provided income Standard.
There was no known affect to Questioned Costs: eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit
as it relates to Medicaid administrative cost compliance audit.
Recommendation: 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.
Section III - Federal Award Findings and Questioned Costs (continued)
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
Program Names: Medical Assistance
Views of Responsible
Officials and Planned
Corrective Actions:
The County agrees with the finding. See corrective action plan.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-007.
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Finding: 2023-007
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Context:
AL # 93.778
Inaccurate Information Entry
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if
a recipient meets specific income 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 8 errors discovered during our procedures that inaccurate information was
entered when determining eligibility. One applicant received assistance although the family
income were above the State provided income Standard.
There was no known affect to Questioned Costs: eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit
as it relates to Medicaid administrative cost compliance audit.
Recommendation: 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.
Section III - Federal Award Findings and Questioned Costs (continued)
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
Program Names: Medical Assistance
Views of Responsible
Officials and Planned
Corrective Actions:
The County agrees with the finding. See corrective action plan.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-007.
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
AL # 93.778
Finding: 2023-008
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
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 that clearly indicates
what actions were performed and the results of those actions.
The County agrees with the finding. See corrective action plan.
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, a participant could have been approved to receive benefits for which they were
not eligible.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-008.
Program Names: Medical Assistance
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 noncountable resources and explained within the
documentation.
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. Of these, one beneficiary received assistance for which the
recipient was not eligible.
Views of Responsible
Officials and Planned
Corrective Actions:
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
Inaccurate Resource Calculation
Questioned Costs: The total questioned costs for the ineligibility error noted above did not meet the minimum
threshold for reporting.
Section III - Federal Award Findings and Questioned Costs (continued)
129
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
AL # 93.778
Finding: 2023-008
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
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 that clearly indicates
what actions were performed and the results of those actions.
The County agrees with the finding. See corrective action plan.
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, a participant could have been approved to receive benefits for which they were
not eligible.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-008.
Program Names: Medical Assistance
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 noncountable resources and explained within the
documentation.
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. Of these, one beneficiary received assistance for which the
recipient was not eligible.
Views of Responsible
Officials and Planned
Corrective Actions:
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
Inaccurate Resource Calculation
Questioned Costs: The total questioned costs for the ineligibility error noted above did not meet the minimum
threshold for reporting.
Section III - Federal Award Findings and Questioned Costs (continued)
129
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
AL # 93.778
Finding: 2023-009
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Program Names: Medical Assistance
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
In accordance with the Medicaid Manual MA-3120, the State sends notification to the
County when a participant is no longer eligible under Supplemental Security Income (SSI)
determination, the County is required to initiate the ex parte review within 5 workdays of
the date the termination appears on the SSI Termination Report, and complete the
redetermination within 4 months of the month the case appears on the SSI Termination
Report and notify the recipient about applicant's ongoing eligibility for Medicaid.
There was 2 applicant/beneficiary not reviewed timely and determined to be eligible for
Medicaid when their SSI benefits were terminated, for which the recipient was not eligible.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-009.
Untimely Review of SSI Terminations
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
AL # 93.778
Finding: 2023-009
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Program Names: Medical Assistance
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
In accordance with the Medicaid Manual MA-3120, the State sends notification to the
County when a participant is no longer eligible under Supplemental Security Income (SSI)
determination, the County is required to initiate the ex parte review within 5 workdays of
the date the termination appears on the SSI Termination Report, and complete the
redetermination within 4 months of the month the case appears on the SSI Termination
Report and notify the recipient about applicant's ongoing eligibility for Medicaid.
There was 2 applicant/beneficiary not reviewed timely and determined to be eligible for
Medicaid when their SSI benefits were terminated, for which the recipient was not eligible.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-009.
Untimely Review of SSI Terminations
Context:
Effect:
Cause:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
Section III - Federal Award Findings and Questioned Costs (continued)
Views of Responsible
Officials and Planned
Corrective Actions:
The County agrees with the finding. See corrective action plan.
We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit
as it relates to Medicaid administrative cost compliance audit.
The County did not initiate ex parte review timely, therefore, no eligibility review was
completed in the required time period. The lack of follow up and certification lead to
applicants receiving Medicaid benefits for which they were not eligible.
Ineffective communication between departments within the Department of Social Services.
One area within DSS received State communications that applicants would no longer be
eligible for SSI benefits and the County needed to conduct an application process. This
information was not shared with other departments in DSS from which the recipient was
also receiving benefits.
Recommendation: Any State communications related to applicants’ benefits received by any DSS department
should be shared with all areas from which the participant receives benefits. State files
should be reviewed internally to ensure all actions have been properly closed and the
corrective action has been taken. Workers should be retrained on what process needs to be
followed when State communications are received.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-010.