US Department of Treasury
Program Name: Coronavirus State and Local Fiscal Recovery Fund
AL# 21.027
Finding: 2023-006 Untimely Adoption of Policy
SIGNIFICANT DEFICENCY
Criteria:
Condition:
Effect:
Section III. Federal Award Findings and Questioned Costs
Late Submission of Data Collection Form
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 report was not finalized until 12 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.
The County agrees with the finding. Please refer to the corrective action plan for details.
In accordance with the U.S. Department of Treasury 31 CFR Part 35, Coronavirus State and Local
Fiscal Recovery Funds Final Rule and the Uniform Guidance, General Financial Management Internal
Controls, Eligible Projects Determination & Documentation Policy, Cost Principles/Allowable Costs
Policy, Civil Rights Compliance / Nondiscrimination Policy, Records Retention Policy are required to
be adopted as condition of receiving the funds.
The County expended the funds as revenue replacement without adopting the policies specific to the
federal award.
The County could use the funds for unallowable costs that were prohibited by the Final Rule.
Cause:
Identification of a
repeat finding:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-007 Untimely Review of SSI Termination
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
This is a repeat finding from the immediate previous audit, 2022-008.
The State sends notification to the County when a participant is no longer eligible under SSI
determination. The County has a certain time period to initiate an ex parte review to determine whether
the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's
Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for
the Aged, Blind and Disabled.
There were 4 beneficiaries not reviewed timely and determined to be eligible for Medicaid when their
SSI benefits were terminated.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
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 could lead to applicants receiving
Medicaid benefits for which they were not eligible.
Section III. Federal Award Findings and Questioned Costs (continued)
The finance office should review the grant agreement and the Uniform Guidance more carefully to
ensure all compliance requirements are meet.
The County agrees with the finding. See the response in the corrective action plan.
County oversight of the new federal grant requirement to have the stated policies in place.
This is a repeat finding from the immediate previous audit, 2022-007.
Cause:
Identification of a
repeat finding:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-007 Untimely Review of SSI Termination
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
This is a repeat finding from the immediate previous audit, 2022-008.
The State sends notification to the County when a participant is no longer eligible under SSI
determination. The County has a certain time period to initiate an ex parte review to determine whether
the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's
Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for
the Aged, Blind and Disabled.
There were 4 beneficiaries not reviewed timely and determined to be eligible for Medicaid when their
SSI benefits were terminated.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
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 could lead to applicants receiving
Medicaid benefits for which they were not eligible.
Section III. Federal Award Findings and Questioned Costs (continued)
The finance office should review the grant agreement and the Uniform Guidance more carefully to
ensure all compliance requirements are meet.
The County agrees with the finding. See the response in the corrective action plan.
County oversight of the new federal grant requirement to have the stated policies in place.
This is a repeat finding from the immediate previous audit, 2022-007.
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-008 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
The County agrees with the finding. See the response in the corrective action plan.
There were 4 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
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.
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.
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient
meets specific standards, and documentation must be maintained to support eligibility determinations.
In accordance with 2 CFR 200, management should have an adequate system of internal controls
procedures in place to ensure an applicant is properly determined or redetermined for benefits.
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.
This is a repeat finding from the immediate previous audit, 2022-009.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-008 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
The County agrees with the finding. See the response in the corrective action plan.
There were 4 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
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.
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.
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient
meets specific standards, and documentation must be maintained to support eligibility determinations.
In accordance with 2 CFR 200, management should have an adequate system of internal controls
procedures in place to ensure an applicant is properly determined or redetermined for benefits.
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.
This is a repeat finding from the immediate previous audit, 2022-009.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-009 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
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)
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
The County agrees with the finding. See the response in the corrective action plan.
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 305,518 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.
This is a repeat finding from the immediate previous audit, 2022-010.
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-009 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
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)
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
The County agrees with the finding. See the response in the corrective action plan.
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 305,518 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.
This is a repeat finding from the immediate previous audit, 2022-010.
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-010 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income
and those amounts agree to information in NC FAST. The results found or documentation made in
case notes should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See the response in the corrective action plan.
This is a repeat finding from the immediate previous audit, 2022-011.
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)
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
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 24 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-010 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income
and those amounts agree to information in NC FAST. The results found or documentation made in
case notes should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See the response in the corrective action plan.
This is a repeat finding from the immediate previous audit, 2022-011.
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)
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
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 24 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
The County agrees with the finding. See the response in the corrective action plan.
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-011 Non-cooperation with Child Support Procedures
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or
medical support or medical support payments from the child’s non-custodial parent. Cooperation
requirement with Social Services and Child Support Agencies must be met or good cause for not
cooperating must be established when determining Medicaid eligibility.
There were 3 errors discovered during our procedures that referrals between DSS and Child Support
Agencies were not properly made.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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 applicants could have been approved for benefits for
which they were not eligible.
Error in reading the ACTS report and/or ineffective case review process.
Section III. Federal Award Findings and Questioned Costs (continued)
SIGNIFICANT DEFICENCY: Finding 2023-007, 2023-008, 2023-009, 2023-010 and 2023-011 also apply to State requirements
and State Awards.
Section IV. State Award Findings and Questioned Costs
The County agrees with the finding. See the response in the corrective action plan.
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 the response in the corrective action plan.
US Department of Treasury
Program Name: Coronavirus State and Local Fiscal Recovery Fund
AL# 21.027
Finding: 2023-006 Untimely Adoption of Policy
SIGNIFICANT DEFICENCY
Criteria:
Condition:
Effect:
Section III. Federal Award Findings and Questioned Costs
Late Submission of Data Collection Form
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 report was not finalized until 12 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.
The County agrees with the finding. Please refer to the corrective action plan for details.
In accordance with the U.S. Department of Treasury 31 CFR Part 35, Coronavirus State and Local
Fiscal Recovery Funds Final Rule and the Uniform Guidance, General Financial Management Internal
Controls, Eligible Projects Determination & Documentation Policy, Cost Principles/Allowable Costs
Policy, Civil Rights Compliance / Nondiscrimination Policy, Records Retention Policy are required to
be adopted as condition of receiving the funds.
The County expended the funds as revenue replacement without adopting the policies specific to the
federal award.
The County could use the funds for unallowable costs that were prohibited by the Final Rule.
Cause:
Identification of a
repeat finding:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-007 Untimely Review of SSI Termination
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
This is a repeat finding from the immediate previous audit, 2022-008.
The State sends notification to the County when a participant is no longer eligible under SSI
determination. The County has a certain time period to initiate an ex parte review to determine whether
the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's
Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for
the Aged, Blind and Disabled.
There were 4 beneficiaries not reviewed timely and determined to be eligible for Medicaid when their
SSI benefits were terminated.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
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 could lead to applicants receiving
Medicaid benefits for which they were not eligible.
Section III. Federal Award Findings and Questioned Costs (continued)
The finance office should review the grant agreement and the Uniform Guidance more carefully to
ensure all compliance requirements are meet.
The County agrees with the finding. See the response in the corrective action plan.
County oversight of the new federal grant requirement to have the stated policies in place.
This is a repeat finding from the immediate previous audit, 2022-007.
Cause:
Identification of a
repeat finding:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-007 Untimely Review of SSI Termination
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
This is a repeat finding from the immediate previous audit, 2022-008.
The State sends notification to the County when a participant is no longer eligible under SSI
determination. The County has a certain time period to initiate an ex parte review to determine whether
the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's
Medicaid, North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for
the Aged, Blind and Disabled.
There were 4 beneficiaries not reviewed timely and determined to be eligible for Medicaid when their
SSI benefits were terminated.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
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 could lead to applicants receiving
Medicaid benefits for which they were not eligible.
Section III. Federal Award Findings and Questioned Costs (continued)
The finance office should review the grant agreement and the Uniform Guidance more carefully to
ensure all compliance requirements are meet.
The County agrees with the finding. See the response in the corrective action plan.
County oversight of the new federal grant requirement to have the stated policies in place.
This is a repeat finding from the immediate previous audit, 2022-007.
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-008 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
The County agrees with the finding. See the response in the corrective action plan.
There were 4 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
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.
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.
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient
meets specific standards, and documentation must be maintained to support eligibility determinations.
In accordance with 2 CFR 200, management should have an adequate system of internal controls
procedures in place to ensure an applicant is properly determined or redetermined for benefits.
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.
This is a repeat finding from the immediate previous audit, 2022-009.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-008 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
The County agrees with the finding. See the response in the corrective action plan.
There were 4 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
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.
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.
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient
meets specific standards, and documentation must be maintained to support eligibility determinations.
In accordance with 2 CFR 200, management should have an adequate system of internal controls
procedures in place to ensure an applicant is properly determined or redetermined for benefits.
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.
This is a repeat finding from the immediate previous audit, 2022-009.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-009 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
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)
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
The County agrees with the finding. See the response in the corrective action plan.
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 305,518 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.
This is a repeat finding from the immediate previous audit, 2022-010.
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-009 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
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)
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
The County agrees with the finding. See the response in the corrective action plan.
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 305,518 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.
This is a repeat finding from the immediate previous audit, 2022-010.
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-010 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income
and those amounts agree to information in NC FAST. The results found or documentation made in
case notes should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See the response in the corrective action plan.
This is a repeat finding from the immediate previous audit, 2022-011.
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)
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
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 24 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-010 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income
and those amounts agree to information in NC FAST. The results found or documentation made in
case notes should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See the response in the corrective action plan.
This is a repeat finding from the immediate previous audit, 2022-011.
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)
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
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 24 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
The County agrees with the finding. See the response in the corrective action plan.
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-011 Non-cooperation with Child Support Procedures
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or
medical support or medical support payments from the child’s non-custodial parent. Cooperation
requirement with Social Services and Child Support Agencies must be met or good cause for not
cooperating must be established when determining Medicaid eligibility.
There were 3 errors discovered during our procedures that referrals between DSS and Child Support
Agencies were not properly made.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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 applicants could have been approved for benefits for
which they were not eligible.
Error in reading the ACTS report and/or ineffective case review process.
Section III. Federal Award Findings and Questioned Costs (continued)
SIGNIFICANT DEFICENCY: Finding 2023-007, 2023-008, 2023-009, 2023-010 and 2023-011 also apply to State requirements
and State Awards.
Section IV. State Award Findings and Questioned Costs
The County agrees with the finding. See the response in the corrective action plan.
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 the response in the corrective action plan.