Northampton County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
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 2024-008 IV-D Cooperation with Child Support
SIGNIFICANT DEFICIENCY
Eligibility
Criteria: 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 determine Medicaid eligibility.
Context: We examined 60 cases from of a total of 262,448 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.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Section III – Federal Award Findings and Questioned Costs
Effect: 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.
Cause: Human error in reading the ACTS report and/or ineffective case review process.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See
Corrective Action Plan.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-008.
Condition: There was 1 error discovered during our procedures that referrals between DSS and Child Support
Agencies were not properly made.
142
Northampton County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
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 2024-009 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Section III – Federal Award Findings and Questioned Costs (continued)
Views of responsible officials and planned corrective actions: The County agrees with the finding. See
Corrective Action Plan.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Criteria: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-009.
Condition: There were 5 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file. Of these 5 errors, one was determined to be an
eligibility error with known questioned costs.
Questioned Costs: As a result of the lack of a proper eligibility determination, federal funds were distributed to
ineligible recipients leading to known questioned costs totaling $2,010. This may result in disallowed costs that will
need to be repaid to the state or federal awarding agency.
Context: We examined 60 cases from of a total of 262,448 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.
Effect: 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.
143
Northampton County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
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 2024-010 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
Section III – Federal Award Findings and Questioned Costs (continued)
Criteria: 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.
Condition: There were 5 errors discovered during our procedures where required information needed for eligibility
determinations were not requested or not requested timely at applications or redeterminations.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 262,448 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.
Effect: 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.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See
Corrective Action Plan.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-010.
144
Northampton County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
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 2024-011 Inaccurate Resources Entry
SIGNIFICANT DEFICIENCY
Eligibility
Section III – Federal Award Findings and Questioned Costs (continued)
Criteria: 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 non-countable resources and
explained within the documentation.
Condition: There were 2 errors discovered during our procedures that resources in the county documentation and
those same resources contained in NC FAST were not the same amounts or files containing resources were not
properly documented to be considered countable or non-countable.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Recommendation: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-011.
Context: We examined 60 cases from of a total of 262,448 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.
Effect: 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.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See
Corrective Action Plan.
145
Northampton County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
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 2024-008 IV-D Cooperation with Child Support
SIGNIFICANT DEFICIENCY
Eligibility
Criteria: 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 determine Medicaid eligibility.
Context: We examined 60 cases from of a total of 262,448 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.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Section III – Federal Award Findings and Questioned Costs
Effect: 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.
Cause: Human error in reading the ACTS report and/or ineffective case review process.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See
Corrective Action Plan.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-008.
Condition: There was 1 error discovered during our procedures that referrals between DSS and Child Support
Agencies were not properly made.
142
Northampton County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
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 2024-009 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Section III – Federal Award Findings and Questioned Costs (continued)
Views of responsible officials and planned corrective actions: The County agrees with the finding. See
Corrective Action Plan.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Criteria: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-009.
Condition: There were 5 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file. Of these 5 errors, one was determined to be an
eligibility error with known questioned costs.
Questioned Costs: As a result of the lack of a proper eligibility determination, federal funds were distributed to
ineligible recipients leading to known questioned costs totaling $2,010. This may result in disallowed costs that will
need to be repaid to the state or federal awarding agency.
Context: We examined 60 cases from of a total of 262,448 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.
Effect: 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.
143
Northampton County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
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 2024-010 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
Section III – Federal Award Findings and Questioned Costs (continued)
Criteria: 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.
Condition: There were 5 errors discovered during our procedures where required information needed for eligibility
determinations were not requested or not requested timely at applications or redeterminations.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 262,448 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.
Effect: 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.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See
Corrective Action Plan.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-010.
144
Northampton County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
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 2024-011 Inaccurate Resources Entry
SIGNIFICANT DEFICIENCY
Eligibility
Section III – Federal Award Findings and Questioned Costs (continued)
Criteria: 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 non-countable resources and
explained within the documentation.
Condition: There were 2 errors discovered during our procedures that resources in the county documentation and
those same resources contained in NC FAST were not the same amounts or files containing resources were not
properly documented to be considered countable or non-countable.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Recommendation: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-011.
Context: We examined 60 cases from of a total of 262,448 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.
Effect: 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.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See
Corrective Action Plan.
145