U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-002
SIGNIFICANT DEFICIENCY
ELIGIBILITY
Criteria:
Condition:
Questioned Costs:
Context:
Section III. Federal Award Findings and Questioned Costs
Section II. Financial Statement Findings
The County's management and other users of the financial statements do not have
accurate information for decisions-making and monitoring of the county's financial
position and adherence to laws, regulations, and other requirements. Errors in financial
reporting could occur and not be detected.
The original net present values recorded for several GASB 87 leases were incorrectly
calculated.
The County should keep good record of the lease schedules and make adjustments
timely.
The County agrees with this finding.
In accordance with 42 CFR 435, documentation must be obtained as needed to
determine if a recipient meets specific standards, and documentation must be
maintained to support eligibility determinations. In accordance with 2 CFR 200,
management should have an adequate system of internal controls procedures in place
to ensure an applicant is properly determined or redetermined for benefits.
There were 5 errors discovered during our procedures that inaccurate information was
entered when determining eligibility.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 650,440 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.
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Finding: 2024-003 Inadequate Request For Information
SIGNIFICANT DEFICIENCY
ELIGIBILITY
Criteria:
Condition:
Questioned Costs:
Context:
This is a repeat finding from the immediate previous audit, 2023-002.
Section III. Federal Award Findings and Questioned Costs (continued)
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
Files should be reviewed internally to ensure proper documentation is in place for
eligibility. Workers should be retrained on what files should contain and the
importance of complete and accurate record keeping. We recommend that all files
include online verifications, documented resources of income and those amounts agree
to information in NC FAST. The results found or documentation made in case notes
should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See Corrective Action Plan in the following
section.
Finding: 2024-003 Inadequate Request For Information
SIGNIFICANT DEFICIENCY
ELIGIBILITY
Criteria:
Condition:
Questioned Costs:
Context:
This is a repeat finding from the immediate previous audit, 2023-002.
Section III. Federal Award Findings and Questioned Costs (continued)
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
Files should be reviewed internally to ensure proper documentation is in place for
eligibility. Workers should be retrained on what files should contain and the
importance of complete and accurate record keeping. We recommend that all files
include online verifications, documented resources of income and those amounts agree
to information in NC FAST. The results found or documentation made in case notes
should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See Corrective Action Plan in the following
section.
In accordance with 42 CFR 435, documentation must be obtained as needed to
determine if a recipient meets specific standards, and documentation must be
maintained to support eligibility determinations. Electronic matches are required at
applications and redeterminations.
There were 6 errors discovered during our procedures where required information
needed for eligibility determinations were not requested or not requested timely at
applications or redeterminations. Of these 6 errors, one was determined to be an
eligibility error with questioned costs.
As a result of the lack of proper eligibility determination, federal funds were
distributed to potential ineligible recipients, leading to known questioned costs totaling
$819. This may result in disallowed costs that will need to be repaid to the federal
awarding agency.
We examined 60 cases from of a total of 650,440 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.
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
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 and applicants could have been
approved for benefits for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
Files should be reviewed internally to ensure proper documentation is in place for
eligibility. Workers should be retrained on what files should contain and the
importance of complete and accurate record keeping. We recommend that all files
include online verifications, documented resources and income and those amounts
agree to information in NC FAST. The results found or documentation made in case
notes should clearly indicate what actions were performed and the results of those
actions.
The County agrees with the finding. See Corrective Action Plan in the following
section.
SIGNIFICANT DEFICIENCY: Findings 2024-002 and 2024-003 also apply to State requirements and
State Awards.
This is a repeat finding from the immediate previous audit, 2023-004.
Section IV. St
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-002
SIGNIFICANT DEFICIENCY
ELIGIBILITY
Criteria:
Condition:
Questioned Costs:
Context:
Section III. Federal Award Findings and Questioned Costs
Section II. Financial Statement Findings
The County's management and other users of the financial statements do not have
accurate information for decisions-making and monitoring of the county's financial
position and adherence to laws, regulations, and other requirements. Errors in financial
reporting could occur and not be detected.
The original net present values recorded for several GASB 87 leases were incorrectly
calculated.
The County should keep good record of the lease schedules and make adjustments
timely.
The County agrees with this finding.
In accordance with 42 CFR 435, documentation must be obtained as needed to
determine if a recipient meets specific standards, and documentation must be
maintained to support eligibility determinations. In accordance with 2 CFR 200,
management should have an adequate system of internal controls procedures in place
to ensure an applicant is properly determined or redetermined for benefits.
There were 5 errors discovered during our procedures that inaccurate information was
entered when determining eligibility.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 650,440 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.
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Finding: 2024-003 Inadequate Request For Information
SIGNIFICANT DEFICIENCY
ELIGIBILITY
Criteria:
Condition:
Questioned Costs:
Context:
This is a repeat finding from the immediate previous audit, 2023-002.
Section III. Federal Award Findings and Questioned Costs (continued)
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
Files should be reviewed internally to ensure proper documentation is in place for
eligibility. Workers should be retrained on what files should contain and the
importance of complete and accurate record keeping. We recommend that all files
include online verifications, documented resources of income and those amounts agree
to information in NC FAST. The results found or documentation made in case notes
should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See Corrective Action Plan in the following
section.
Finding: 2024-003 Inadequate Request For Information
SIGNIFICANT DEFICIENCY
ELIGIBILITY
Criteria:
Condition:
Questioned Costs:
Context:
This is a repeat finding from the immediate previous audit, 2023-002.
Section III. Federal Award Findings and Questioned Costs (continued)
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
Files should be reviewed internally to ensure proper documentation is in place for
eligibility. Workers should be retrained on what files should contain and the
importance of complete and accurate record keeping. We recommend that all files
include online verifications, documented resources of income and those amounts agree
to information in NC FAST. The results found or documentation made in case notes
should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See Corrective Action Plan in the following
section.
In accordance with 42 CFR 435, documentation must be obtained as needed to
determine if a recipient meets specific standards, and documentation must be
maintained to support eligibility determinations. Electronic matches are required at
applications and redeterminations.
There were 6 errors discovered during our procedures where required information
needed for eligibility determinations were not requested or not requested timely at
applications or redeterminations. Of these 6 errors, one was determined to be an
eligibility error with questioned costs.
As a result of the lack of proper eligibility determination, federal funds were
distributed to potential ineligible recipients, leading to known questioned costs totaling
$819. This may result in disallowed costs that will need to be repaid to the federal
awarding agency.
We examined 60 cases from of a total of 650,440 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.
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
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 and applicants could have been
approved for benefits for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
Files should be reviewed internally to ensure proper documentation is in place for
eligibility. Workers should be retrained on what files should contain and the
importance of complete and accurate record keeping. We recommend that all files
include online verifications, documented resources and income and those amounts
agree to information in NC FAST. The results found or documentation made in case
notes should clearly indicate what actions were performed and the results of those
actions.
The County agrees with the finding. See Corrective Action Plan in the following
section.
SIGNIFICANT DEFICIENCY: Findings 2024-002 and 2024-003 also apply to State requirements and
State Awards.
This is a repeat finding from the immediate previous audit, 2023-004.
Section IV. St