Vance 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: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-004 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a
repeat finding:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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.
Section III. Federal Award Findings and Questioned Costs
The County agrees with the finding. See Corrective Action Plan in the following
section.
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 2 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 830,748 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 North Carolina Families Accessing Services
through Technology (NC FAST) and a participant could have been approved for
benefits for which they were not eligible.
This is a repeat finding from the immediate previous audit, 2023-008.
138
Vance 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: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-005 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a
repeat finding:
Recommendation:
Views of responsible
officials and planned
corrective 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 was no known affect to eligibility and there were no known questioned costs.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
Section III. Federal Award Findings and Questioned Costs (continued)
There were 4 errors discovered during our procedures that inaccurate information
was entered when determining eligibility.
This is a repeat finding from the immediate previous audit, 2023-009.
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.
We examined 60 cases from of a total of 830,748 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.
139
Vance 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: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-006 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a
repeat finding:
Recommendation:
This is a repeat finding from the immediate previous audit, 2023-010.
Section III. Federal Award Findings and Questioned Costs (continued)
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 4 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.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 830,748 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.
140
Vance County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
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 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a
repeat finding:
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
The County agrees with the finding. See Corrective Action Plan in the following
section.
We examined 60 cases from of a total of 830,748 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.
There were 14 errors discovered during our procedures where required information
needed for eligibility determinations were not requested or not requested timely at
applications or redeterminations. Of these 14 errors, one was determined to be an
eligibility error with potential questioned costs.
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.
This is a repeat finding from the immediate previous audit, 2023-012.
Section III. Federal Award Findings and Questioned Costs (continued)
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.
141
Vance 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
N.C. Office of State Budget and Management
Program Name: Regional Economic Development Reserve
Finding: 2024-008 Funds Management
SIGNIFICANT DEFICENCY
Cash Management
Criteria:
Condition:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Section IV. State Award Findings and 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.
The County agrees with the finding. See Corrective Action Plan in the following
section.
In accordance with North Carolina General Statute (G.S.) 143C-6-23 and the grant
contract with North Carolina Office of State Budget and Management, the grant
funds should be accounted for in a separate fund and accounting structure within the
recipient's central accounting and/or grant management system.
The County agrees with the finding. See Corrective Action Plan in the following
section.
The grant funds were accounted for in County General Fund instead of a separate
fund.
Grant funds were not properly managed as required.
Budget was adopted when the funds were awarded to the County before the grant
contracts were signed.
Account each source of fund separately in County accounting system.
SIGNIFICANT DEFICENCY: Finding 2024-004, 2024-005, 2024-006, and 2024-007 also apply to State
requirements and State Awards.
142
Vance 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: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-004 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a
repeat finding:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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.
Section III. Federal Award Findings and Questioned Costs
The County agrees with the finding. See Corrective Action Plan in the following
section.
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 2 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 830,748 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 North Carolina Families Accessing Services
through Technology (NC FAST) and a participant could have been approved for
benefits for which they were not eligible.
This is a repeat finding from the immediate previous audit, 2023-008.
138
Vance 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: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-005 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a
repeat finding:
Recommendation:
Views of responsible
officials and planned
corrective 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 was no known affect to eligibility and there were no known questioned costs.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
Section III. Federal Award Findings and Questioned Costs (continued)
There were 4 errors discovered during our procedures that inaccurate information
was entered when determining eligibility.
This is a repeat finding from the immediate previous audit, 2023-009.
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.
We examined 60 cases from of a total of 830,748 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.
139
Vance 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: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-006 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a
repeat finding:
Recommendation:
This is a repeat finding from the immediate previous audit, 2023-010.
Section III. Federal Award Findings and Questioned Costs (continued)
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 4 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.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 830,748 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.
140
Vance County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
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 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a
repeat finding:
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
The County agrees with the finding. See Corrective Action Plan in the following
section.
We examined 60 cases from of a total of 830,748 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.
There were 14 errors discovered during our procedures where required information
needed for eligibility determinations were not requested or not requested timely at
applications or redeterminations. Of these 14 errors, one was determined to be an
eligibility error with potential questioned costs.
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.
This is a repeat finding from the immediate previous audit, 2023-012.
Section III. Federal Award Findings and Questioned Costs (continued)
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.
141
Vance 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
N.C. Office of State Budget and Management
Program Name: Regional Economic Development Reserve
Finding: 2024-008 Funds Management
SIGNIFICANT DEFICENCY
Cash Management
Criteria:
Condition:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Section IV. State Award Findings and 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.
The County agrees with the finding. See Corrective Action Plan in the following
section.
In accordance with North Carolina General Statute (G.S.) 143C-6-23 and the grant
contract with North Carolina Office of State Budget and Management, the grant
funds should be accounted for in a separate fund and accounting structure within the
recipient's central accounting and/or grant management system.
The County agrees with the finding. See Corrective Action Plan in the following
section.
The grant funds were accounted for in County General Fund instead of a separate
fund.
Grant funds were not properly managed as required.
Budget was adopted when the funds were awarded to the County before the grant
contracts were signed.
Account each source of fund separately in County accounting system.
SIGNIFICANT DEFICENCY: Finding 2024-004, 2024-005, 2024-006, and 2024-007 also apply to State
requirements and State Awards.
142