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: 2024-001 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
Section I. Summary of Auditors' Results (continued)
Section II. Financial Statement Findings
Type of auditors' report issued on compliance for major State programs:
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.
Section III. Federal Award Findings and Questioned Costs
130Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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 Inaccurate Resource Entry
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
There was 1 error 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.
We examined 60 cases from of a total of 1,076,004 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 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.
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 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.
Section III. Federal Award Findings and Questioned Costs (continued)
131
Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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 Inaccurate Resource Entry
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
There was 1 error 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.
We examined 60 cases from of a total of 1,076,004 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 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.
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 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.
Section III. Federal Award Findings and Questioned Costs (continued)
131Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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: 2024-003 Inadequate Request For Information
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
Condition:
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 2 errors discovered during our procedures where required information needed for
eligibility determinations were not requested or not requested timely at applications or
redeterminations.
Section III. Federal Award Findings and Questioned Costs (continued)
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 1,076,004 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 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.
Case files should be reviewed internally to ensure correct calculations of resources are made,
proper information is included in the case file, 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.
There were 5 errors discovered during our procedures where resources were imcorrectly
calculated or were not properly documented in the case file.
132
Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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: 2024-003 Inadequate Request For Information
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
Condition:
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 2 errors discovered during our procedures where required information needed for
eligibility determinations were not requested or not requested timely at applications or
redeterminations.
Section III. Federal Award Findings and Questioned Costs (continued)
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 1,076,004 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 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.
Case files should be reviewed internally to ensure correct calculations of resources are made,
proper information is included in the case file, 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.
There were 5 errors discovered during our procedures where resources were imcorrectly
calculated or were not properly documented in the case file.
132Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 1,076,004 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.
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 all required verifications have been completed
and information requested from the applicant/beneficiary or through various systems have been
included 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 Corrective Action Plan in the following section.
Section III. Federal Award Findings and Questioned Costs (continued)
133
Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Food and Nutrition Services (FNS) Cluster
AL #: 10.551 and 10.561
Finding: 2024-004 Internal Controls Related to Food and Nutrition Services Eligibility
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Section III. Federal Award Findings and Questioned Costs (continued)
Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and
maintain effective internal control over the Federal award that provides reasonable assurance
that the non-federal entity is managing the Federal award in compliance with Federal statutes,
regulations, and the terms and conditions of the Federal award. The State has provided
policies and procedures to ensure that the County is meeting the federal guidance, relevant
policies are:
Food and Nutrition Services Policy 305 describes the verification sources and requirements
and the FNS units primary responsibility for providing documentary evidence to support
statements on applications and recertifications and procedures required if the statements by
applicant/beneficiary are questionable.
Food and Nutrition Services Policy 300 describes the sources of income countable and not
countable to the household for determining financial eligibility.
Food and Nutrition Services Policy 310 describes the procedures related to verifying changes
in income (i.e. termination, end of contract, temporary, etc.).
There were a total of 2 errors found in our testing, both instances where earned income was
incorrectly caclculated and entered in NCFAST. Of these 2 errors, 1 of these could potentially
be an eligibility error.
Due to the nature of the populations provided from which the samples were chosen, we are
unable to calculate questioned costs for the above mentioned potential eligibility issue.
We examined 25 of 96,362 FNS cases from a report of all active FNS beneficiaries provided by
the County's Department of Social Services. The finding is being reported with the financial
statement audit as it relates to FNS 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.
134
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: 2024-001 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
Section I. Summary of Auditors' Results (continued)
Section II. Financial Statement Findings
Type of auditors' report issued on compliance for major State programs:
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.
Section III. Federal Award Findings and Questioned Costs
130Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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 Inaccurate Resource Entry
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
There was 1 error 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.
We examined 60 cases from of a total of 1,076,004 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 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.
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 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.
Section III. Federal Award Findings and Questioned Costs (continued)
131
Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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 Inaccurate Resource Entry
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
There was 1 error 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.
We examined 60 cases from of a total of 1,076,004 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 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.
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 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.
Section III. Federal Award Findings and Questioned Costs (continued)
131Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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: 2024-003 Inadequate Request For Information
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
Condition:
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 2 errors discovered during our procedures where required information needed for
eligibility determinations were not requested or not requested timely at applications or
redeterminations.
Section III. Federal Award Findings and Questioned Costs (continued)
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 1,076,004 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 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.
Case files should be reviewed internally to ensure correct calculations of resources are made,
proper information is included in the case file, 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.
There were 5 errors discovered during our procedures where resources were imcorrectly
calculated or were not properly documented in the case file.
132
Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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: 2024-003 Inadequate Request For Information
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
Condition:
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 2 errors discovered during our procedures where required information needed for
eligibility determinations were not requested or not requested timely at applications or
redeterminations.
Section III. Federal Award Findings and Questioned Costs (continued)
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 1,076,004 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 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.
Case files should be reviewed internally to ensure correct calculations of resources are made,
proper information is included in the case file, 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.
There were 5 errors discovered during our procedures where resources were imcorrectly
calculated or were not properly documented in the case file.
132Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 1,076,004 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.
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 all required verifications have been completed
and information requested from the applicant/beneficiary or through various systems have been
included 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 Corrective Action Plan in the following section.
Section III. Federal Award Findings and Questioned Costs (continued)
133
Burke County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Food and Nutrition Services (FNS) Cluster
AL #: 10.551 and 10.561
Finding: 2024-004 Internal Controls Related to Food and Nutrition Services Eligibility
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Section III. Federal Award Findings and Questioned Costs (continued)
Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and
maintain effective internal control over the Federal award that provides reasonable assurance
that the non-federal entity is managing the Federal award in compliance with Federal statutes,
regulations, and the terms and conditions of the Federal award. The State has provided
policies and procedures to ensure that the County is meeting the federal guidance, relevant
policies are:
Food and Nutrition Services Policy 305 describes the verification sources and requirements
and the FNS units primary responsibility for providing documentary evidence to support
statements on applications and recertifications and procedures required if the statements by
applicant/beneficiary are questionable.
Food and Nutrition Services Policy 300 describes the sources of income countable and not
countable to the household for determining financial eligibility.
Food and Nutrition Services Policy 310 describes the procedures related to verifying changes
in income (i.e. termination, end of contract, temporary, etc.).
There were a total of 2 errors found in our testing, both instances where earned income was
incorrectly caclculated and entered in NCFAST. Of these 2 errors, 1 of these could potentially
be an eligibility error.
Due to the nature of the populations provided from which the samples were chosen, we are
unable to calculate questioned costs for the above mentioned potential eligibility issue.
We examined 25 of 96,362 FNS cases from a report of all active FNS beneficiaries provided by
the County's Department of Social Services. The finding is being reported with the financial
statement audit as it relates to FNS 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.
134