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: 2024-002 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Section II. Financial Statement Findings (continued)
This is a repeat finding from the immediate previous audit, 2023-002.
We examined 60 cases from of a total of 607,835 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.
Section III. Federal Award Findings and Questioned Costs
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 4 errors discovered during our procedures where income or household size
was incorrectly calculated or inaccurate information was entered into the case file.
There was no known affect to eligibility and there were no known questioned costs.
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: 2024-003 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context: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: 2024-004 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
The County agrees with the finding. See Corrective Action Plan in the following
section.
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.
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 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 3 errors discovered during our procedures where required information
needed for eligibility determinations were not requested or not requested timely at
applications 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 607,835 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.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
This is a repeat finding from the immediate previous audit, 2023-004.
Effect:
Identification of a repeat
finding:
Cause:
This is a repeat finding from the immediate previous audit, 2023-003.
The County agrees with the finding. See Corrective Action Plan in the following
section.
Section III. Federal Award Findings and Questioned Costs (Continued)
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.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
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.
We examined 60 cases from of a total of 607,835 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.
There was no known affect to eligibility and there were no known questioned costs.
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 were 4 errors discovered during our procedures where resources were
imcorrectly calculated or were not properly documented in the case file.
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 # 93.778Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
SIGNIFICANT DEFICENCY: Finding 2024-002, 2024-003, and 2024-004 also apply to State requirements and State
Awards.
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: 2024-004 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
The County agrees with the finding. See Corrective Action Plan in the following
section.
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.
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 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 3 errors discovered during our procedures where required information
needed for eligibility determinations were not requested or not requested timely at
applications 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 607,835 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.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
This is a repeat finding from the immediate previous audit, 2023-004.
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: 2024-002 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Section II. Financial Statement Findings (continued)
This is a repeat finding from the immediate previous audit, 2023-002.
We examined 60 cases from of a total of 607,835 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.
Section III. Federal Award Findings and Questioned Costs
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 4 errors discovered during our procedures where income or household size
was incorrectly calculated or inaccurate information was entered into the case file.
There was no known affect to eligibility and there were no known questioned costs.
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: 2024-003 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context: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: 2024-004 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
The County agrees with the finding. See Corrective Action Plan in the following
section.
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.
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 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 3 errors discovered during our procedures where required information
needed for eligibility determinations were not requested or not requested timely at
applications 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 607,835 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.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
This is a repeat finding from the immediate previous audit, 2023-004.
Effect:
Identification of a repeat
finding:
Cause:
This is a repeat finding from the immediate previous audit, 2023-003.
The County agrees with the finding. See Corrective Action Plan in the following
section.
Section III. Federal Award Findings and Questioned Costs (Continued)
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.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
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.
We examined 60 cases from of a total of 607,835 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.
There was no known affect to eligibility and there were no known questioned costs.
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 were 4 errors discovered during our procedures where resources were
imcorrectly calculated or were not properly documented in the case file.
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 # 93.778Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
SIGNIFICANT DEFICENCY: Finding 2024-002, 2024-003, and 2024-004 also apply to State requirements and State
Awards.
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: 2024-004 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
The County agrees with the finding. See Corrective Action Plan in the following
section.
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.
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 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 3 errors discovered during our procedures where required information
needed for eligibility determinations were not requested or not requested timely at
applications 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 607,835 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.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
This is a repeat finding from the immediate previous audit, 2023-004.