U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.
U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.
U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.
U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.
U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.
U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.
U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.
U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.
U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.
U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.
U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.
U.S. Department of Health and Human Services
Passed through the N.C. Department of Health and Human Services, Division of Social Services
Program Name:
DSS Crosscutting (State)
Medicaid Cluster AL#93.778 (XIX-MAP24)
Finding: 2024-001
Significant Deficiency, non-material non-compliance
Special Tests and Provisions (Enterprise Program Integrity)
Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, Counties must acquire adequate case documentation to substantiate the claim entry into the NC Fast Enterprise Program Integrity (“EPI”) system. This information includes, but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment.
Condition: We noted one instance of a claim entered in EPI where adequate case documentation to substantiate the claim entry was not maintained. The budget calculated during the initial investigation in the claims file does not agree to the amount entered in EPI to be collected on by the County.
Context: We sampled 40 claims that were current in the EPI system and noted the above condition in 1 (2.5%) of the claims tested. To date, the County has reviewed the budget and corrected the amount in EPI system, as well as the casefile.
Effect: The County may not have accurate supporting documentation for claims entered in EPI system. There is a risk that claims may not be valid as a result.
Cause: Documentation to support a claim entered into EPI was not accurate.
Questioned Costs: None, no payments have been collected by the County to date on this claim.
Recommendation: County DSS staff should implement controls to ensure that all documentation is maintained and agrees to what was entered into EPI.
Views of Responsible Officials and Planned Corrective Actions: See Corrective Action Plan submitted with this report.