Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-005 Non-cooperation with IV-D Referrals
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
The County agrees with the finding. See Corrective Action Plan in the following section.
Section II - Financial Statement Findings (continued)
Unapproved and ineligible purchases could be made, and the County’s DSS-1571
reimbursement could be overstated.
Ineffective record keeping and ineffective purchasing process, incomplete documentation,
and incorrect application of rules for computer equipment/services management.
Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when making such purchases. Copies of the filed Computer Equipment
Acquisition Plan and NCDHHS approval memorandum should be retained and regularly
reviewed.
In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated
and referred to the Child Support Enforcement Agency (IV-D). 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 576,600 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.
Section III - Federal Award Findings and Questioned Costs
This is a repeat finding from the immediate previous audit, 2023-002.
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.
170Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-006 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
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 eligibility.
There was 1 error 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.
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.
This is a repeat finding from the immediate previous audit, 2023-004.
We examined 60 cases from of a total of 576,600 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.
Human error in reading the Automated Collection and Tracking System (ACTS) report
and/or ineffective case review process.
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 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.
171
Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-006 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
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 eligibility.
There was 1 error 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.
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.
This is a repeat finding from the immediate previous audit, 2023-004.
We examined 60 cases from of a total of 576,600 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.
Human error in reading the Automated Collection and Tracking System (ACTS) report
and/or ineffective case review process.
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 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.
171Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-007 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Section III - Federal Award Findings and Questioned Costs (Continued)
There was no known affect to eligibility and there were no known questioned costs.
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.
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 2 errors discovered during our procedures where income or household size was
incorrectly calculated or inaccurate information was entered into the case file.
This is a repeat finding from the immediate previous audit, 2023-005.
The County agrees with the finding. See Corrective Action Plan in the following section.
We examined 60 cases from of a total of 576,600 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.
172
Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-007 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Section III - Federal Award Findings and Questioned Costs (Continued)
There was no known affect to eligibility and there were no known questioned costs.
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.
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 2 errors discovered during our procedures where income or household size was
incorrectly calculated or inaccurate information was entered into the case file.
This is a repeat finding from the immediate previous audit, 2023-005.
The County agrees with the finding. See Corrective Action Plan in the following section.
We examined 60 cases from of a total of 576,600 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.
172Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
Section IV - State Award Findings and Questioned Costs
The County agrees with the finding. See Corrective Action Plan in the following section.
Section III - Federal Award Findings and Questioned Costs (Continued)
SIGNIFICANT DEFICENCY: Finding 2024-005, 2024-006, and 2024-007 also apply to State requirements and State Awards.
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.
173
Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-005 Non-cooperation with IV-D Referrals
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
The County agrees with the finding. See Corrective Action Plan in the following section.
Section II - Financial Statement Findings (continued)
Unapproved and ineligible purchases could be made, and the County’s DSS-1571
reimbursement could be overstated.
Ineffective record keeping and ineffective purchasing process, incomplete documentation,
and incorrect application of rules for computer equipment/services management.
Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when making such purchases. Copies of the filed Computer Equipment
Acquisition Plan and NCDHHS approval memorandum should be retained and regularly
reviewed.
In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated
and referred to the Child Support Enforcement Agency (IV-D). 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 576,600 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.
Section III - Federal Award Findings and Questioned Costs
This is a repeat finding from the immediate previous audit, 2023-002.
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.
170Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-006 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
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 eligibility.
There was 1 error 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.
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.
This is a repeat finding from the immediate previous audit, 2023-004.
We examined 60 cases from of a total of 576,600 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.
Human error in reading the Automated Collection and Tracking System (ACTS) report
and/or ineffective case review process.
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 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.
171
Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-006 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
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 eligibility.
There was 1 error 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.
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.
This is a repeat finding from the immediate previous audit, 2023-004.
We examined 60 cases from of a total of 576,600 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.
Human error in reading the Automated Collection and Tracking System (ACTS) report
and/or ineffective case review process.
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 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.
171Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-007 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Section III - Federal Award Findings and Questioned Costs (Continued)
There was no known affect to eligibility and there were no known questioned costs.
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.
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 2 errors discovered during our procedures where income or household size was
incorrectly calculated or inaccurate information was entered into the case file.
This is a repeat finding from the immediate previous audit, 2023-005.
The County agrees with the finding. See Corrective Action Plan in the following section.
We examined 60 cases from of a total of 576,600 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.
172
Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL # 93.778
Finding: 2024-007 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Section III - Federal Award Findings and Questioned Costs (Continued)
There was no known affect to eligibility and there were no known questioned costs.
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.
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 2 errors discovered during our procedures where income or household size was
incorrectly calculated or inaccurate information was entered into the case file.
This is a repeat finding from the immediate previous audit, 2023-005.
The County agrees with the finding. See Corrective Action Plan in the following section.
We examined 60 cases from of a total of 576,600 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.
172Granville County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
Section IV - State Award Findings and Questioned Costs
The County agrees with the finding. See Corrective Action Plan in the following section.
Section III - Federal Award Findings and Questioned Costs (Continued)
SIGNIFICANT DEFICENCY: Finding 2024-005, 2024-006, and 2024-007 also apply to State requirements and State Awards.
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.
173