Hertford 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 Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-006 Untimely Review of SSI Termination
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
There were 1 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid
when their SSI benefits were terminated.
There was no known affect to eligibility and there were no known questioned costs.
Any State communications related to applicants’ benefits received by any DSS department 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
The State sends notification to the County when a participant is no longer eligible under 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.
We examined 60 cases from of a total of 353,314 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 agrees with the finding. See the response in the corrective action plan.
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 could lead to applicants receiving
Medicaid benefits for which they were not eligible.
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 application process. This information was not shared
with other departments in DSS from which the recipient was also receiving benefits.
This is a repeat finding from the immediate previous audit, 2023-007.
116
Hertford 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 Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-007 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
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 were 3 errors discovered during our procedures where income or household size was
incorrectly calculated or inaccurate information was entered into the case file.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 353,314 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.
This is a repeat finding from the immediate previous audit, 2023-008.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income
and those amounts agree to information in NC FAST. The results found or documentation made in
case notes should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See the response in the corrective action plan.
Section III. Federal Award Findings and Questioned Costs (continued)
117
Hertford 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 Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-008 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income
and those amounts agree to information in NC FAST. The results found or documentation made in
case notes should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See the response in the corrective action plan.
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.
There was 1 error discovered during our procedures where resources were imcorrectly 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 353,314 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, 2023-009.
Section III. Federal Award Findings and Questioned Costs (continued)
118
Hertford 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 Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-009 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:
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance 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.
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 24 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 24 errors, two were 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.
We examined 60 cases from of a total of 353,314 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, 2023-010.
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 the response in the corrective action plan.
Section III. Federal Award Findings and Questioned Costs (continued)
119
Hertford 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 Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-006 Untimely Review of SSI Termination
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
There were 1 applicants/beneficiaries not reviewed timely and determined to be eligible for Medicaid
when their SSI benefits were terminated.
There was no known affect to eligibility and there were no known questioned costs.
Any State communications related to applicants’ benefits received by any DSS department 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
The State sends notification to the County when a participant is no longer eligible under 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.
We examined 60 cases from of a total of 353,314 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 agrees with the finding. See the response in the corrective action plan.
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 could lead to applicants receiving
Medicaid benefits for which they were not eligible.
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 application process. This information was not shared
with other departments in DSS from which the recipient was also receiving benefits.
This is a repeat finding from the immediate previous audit, 2023-007.
116
Hertford 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 Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-007 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
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 were 3 errors discovered during our procedures where income or household size was
incorrectly calculated or inaccurate information was entered into the case file.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 353,314 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.
This is a repeat finding from the immediate previous audit, 2023-008.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income
and those amounts agree to information in NC FAST. The results found or documentation made in
case notes should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See the response in the corrective action plan.
Section III. Federal Award Findings and Questioned Costs (continued)
117
Hertford 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 Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-008 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance for which they were not eligible.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
Files should be reviewed internally to ensure proper documentation is in place for eligibility. Workers
should be retrained on what files should contain and the importance of complete and accurate record
keeping. We recommend that all files include online verifications, documented resources of income
and those amounts agree to information in NC FAST. The results found or documentation made in
case notes should clearly indicate what actions were performed and the results of those actions.
The County agrees with the finding. See the response in the corrective action plan.
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.
There was 1 error discovered during our procedures where resources were imcorrectly 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 353,314 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, 2023-009.
Section III. Federal Award Findings and Questioned Costs (continued)
118
Hertford 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 Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-009 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:
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance 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.
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 24 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 24 errors, two were 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.
We examined 60 cases from of a total of 353,314 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, 2023-010.
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 the response in the corrective action plan.
Section III. Federal Award Findings and Questioned Costs (continued)
119