Richmond County
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: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-005 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
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: 2024-006 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
There were 2 errors discovered during our procedures that referrals between DSS and Child Support Agencies
were not properly made.
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 noncustodial
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.
For those certifications/re-certifications there was a chance that information was not properly documented and
reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant
could have been approved for benefits for which they were not eligible.
We examined 60 cases from of a total of 826,901 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.
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.
This is a repeat finding from the immediate previous audit, 2023-004.
There were 4 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file.
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.
Section III - Federal Award Findings and Questioned Costs
There was no known affect to eligibility and there were no known questioned costs.
134
Richmond County
Schedule of Findings and Questioned Costs
For The Year Ended June 30, 2024
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
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: 2024-007 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
This is a repeat finding from the immediate previous audit, 2023-006.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 826,901 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 correct income and/or household size calculations, 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.
This is a repeat finding from the immediate previous audit, 2023-005.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
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.
There were 6 errors discovered during our procedures where resources were incorrectly calculated or were not
properly documented in 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 826,901 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.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
135
Richmond County
Schedule of Findings and Questioned Costs
For The Year Ended June 30, 2024
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
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: 2024-007 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
This is a repeat finding from the immediate previous audit, 2023-006.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 826,901 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 toRichmond County
Schedule of Findings and Questioned Costs
For The Year Ended June 30, 2024
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: 2024-008 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
We examined 60 cases from of a total of 826,901 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.
This is a repeat finding from the immediate previous audit, 2023-007.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
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.
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.
There was no known affect to eligibility and there were no known questioned costs.
136 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 correct income and/or household size calculations, 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.
This is a repeat finding from the immediate previous audit, 2023-005.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
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.
There were 6 errors discovered during our procedures where resources were incorrectly calculated or were not
properly documented in 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 826,901 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.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
135
Richmond County
Schedule of Findings and Questioned Costs
For The Year Ended June 30, 2024
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: 2024-008 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
We examined 60 cases from of a total of 826,901 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.
This is a repeat finding from the immediate previous audit, 2023-007.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
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.
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.
There was no known affect to eligibility and there were no known questioned costs.
136
Richmond County
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: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-009 Untimely Review of SSI Terminations
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
As a result of the lack of a proper eligibility determination, federal funds were distributed to ineligible
recipients. Due to the nature of these types of eligibility determinations and the lack of a proper review by the
department, the auditor is unable to determine the known or likely questioned costs.
Ineffective communication between departments within the Department of Social Services. One area within
DSS received State communications that applicants would no longer be eligible for SSI benefits and the County
needed to conduct an ex-parte review. This information was not shared with other departments in DSS from
which the recipient was also receiving benefits.
The County agrees with the finding. See Corrective Action Plan in the following section.
Any State communications related to applicants/beneficiaries should be shared with all areas from which the
participant receives benefits. State files should be reviewed internally to ensure all actions have been properly
closed and the corrective action has been taken. Workers should be retrained on what process needs to be
followed when State communications are received.
Section III - Federal Award Findings and Questioned Costs (continued)
In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a
participant is no longer eligible under a SSI determination. The County has a certain time period to initiate an
ex-parte review to determine whether the recipient qualifies for Medicaid under any other coverage group, such
as Family and Children's Medicaid, North Carolina Health Choice for Children, Work First Family Assistance,
or Medicaid for the Aged, Blind and Disabled.
There were 3 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when
their SSI benefits were terminated. Of these 3 errors, one was determined to be an eligibility error with
potential questioned costs.
We examined 60 cases from of a total of 826,901 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.
The County did not initiate ex-parte review timely, therefore, no eligibility review was completed in the required
time period. The lack of follow up and certification lead to applicants receiving Medicaid benefits for which
they were not eligible.
SIGNIFICANT DEFICENCY: Finding 2024-005, 2024-006, 2024-007, 2024-008, 2024-009 also apply to State requirements and State Awards.
Section IV - State Award Findings and Questioned Costs
137
Richmond County
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: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-005 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
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: 2024-006 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
There were 2 errors discovered during our procedures that referrals between DSS and Child Support Agencies
were not properly made.
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 noncustodial
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.
For those certifications/re-certifications there was a chance that information was not properly documented and
reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant
could have been approved for benefits for which they were not eligible.
We examined 60 cases from of a total of 826,901 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.
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.
This is a repeat finding from the immediate previous audit, 2023-004.
There were 4 errors discovered during our procedures where income or household size was incorrectly
calculated or inaccurate information was entered into the case file.
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.
Section III - Federal Award Findings and Questioned Costs
There was no known affect to eligibility and there were no known questioned costs.
134
Richmond County
Schedule of Findings and Questioned Costs
For The Year Ended June 30, 2024
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
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: 2024-007 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
This is a repeat finding from the immediate previous audit, 2023-006.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 826,901 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 correct income and/or household size calculations, 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.
This is a repeat finding from the immediate previous audit, 2023-005.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
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.
There were 6 errors discovered during our procedures where resources were incorrectly calculated or were not
properly documented in 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 826,901 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.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
135
Richmond County
Schedule of Findings and Questioned Costs
For The Year Ended June 30, 2024
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
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: 2024-007 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
This is a repeat finding from the immediate previous audit, 2023-006.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 826,901 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 toRichmond County
Schedule of Findings and Questioned Costs
For The Year Ended June 30, 2024
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: 2024-008 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
We examined 60 cases from of a total of 826,901 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.
This is a repeat finding from the immediate previous audit, 2023-007.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
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.
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.
There was no known affect to eligibility and there were no known questioned costs.
136 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 correct income and/or household size calculations, 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.
This is a repeat finding from the immediate previous audit, 2023-005.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
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.
There were 6 errors discovered during our procedures where resources were incorrectly calculated or were not
properly documented in 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 826,901 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.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
135
Richmond County
Schedule of Findings and Questioned Costs
For The Year Ended June 30, 2024
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: 2024-008 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
We examined 60 cases from of a total of 826,901 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.
This is a repeat finding from the immediate previous audit, 2023-007.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
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.
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.
There was no known affect to eligibility and there were no known questioned costs.
136
Richmond County
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: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-009 Untimely Review of SSI Terminations
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
As a result of the lack of a proper eligibility determination, federal funds were distributed to ineligible
recipients. Due to the nature of these types of eligibility determinations and the lack of a proper review by the
department, the auditor is unable to determine the known or likely questioned costs.
Ineffective communication between departments within the Department of Social Services. One area within
DSS received State communications that applicants would no longer be eligible for SSI benefits and the County
needed to conduct an ex-parte review. This information was not shared with other departments in DSS from
which the recipient was also receiving benefits.
The County agrees with the finding. See Corrective Action Plan in the following section.
Any State communications related to applicants/beneficiaries should be shared with all areas from which the
participant receives benefits. State files should be reviewed internally to ensure all actions have been properly
closed and the corrective action has been taken. Workers should be retrained on what process needs to be
followed when State communications are received.
Section III - Federal Award Findings and Questioned Costs (continued)
In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a
participant is no longer eligible under a SSI determination. The County has a certain time period to initiate an
ex-parte review to determine whether the recipient qualifies for Medicaid under any other coverage group, such
as Family and Children's Medicaid, North Carolina Health Choice for Children, Work First Family Assistance,
or Medicaid for the Aged, Blind and Disabled.
There were 3 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid when
their SSI benefits were terminated. Of these 3 errors, one was determined to be an eligibility error with
potential questioned costs.
We examined 60 cases from of a total of 826,901 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.
The County did not initiate ex-parte review timely, therefore, no eligibility review was completed in the required
time period. The lack of follow up and certification lead to applicants receiving Medicaid benefits for which
they were not eligible.
SIGNIFICANT DEFICENCY: Finding 2024-005, 2024-006, 2024-007, 2024-008, 2024-009 also apply to State requirements and State Awards.
Section IV - State Award Findings and Questioned Costs
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