CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2021
Views of responsible
officials:
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)
CFDA# 93.778
Finding 2021-009 IV-D Non-Cooperation
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of Responsible
officials and
corrective action
plans:
Section III. Federal Award Findings and Questioned Costs (continued)
The county agrees with the finding. Please refer to the corrective action plan for details.
This is a repeat finding from the immediate previous audit, 2020-005
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 determine eligibility. The results found or documentation made in
case notes that clearly indicates what actions were performed and the results of those actions.
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.
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.
There was 3 errors discovered during our procedures that referrals between DSS and Child
Support Agencies were not properly made.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from 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 this finding. Please refer to the corrective action plan for details.
118
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2021
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)
CFDA# 93.778
Finding 2021-010 Inaccurate Information Entry
NONCOMPLIANCE / SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of Responsible
officials and
corrective action
plans:
The county agrees with the finding. Please refer to the corrective action plan for details.
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.
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a
recipient meets specific income 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 15 errors discovered during our procedures that inaccurate information was entered
when determining eligibility. One applicant received assistance after moved out of State.
This is a repeat finding from the immediate previous audit, 2020-006
Section III. Federal Award Findings and Questioned Costs (continued)
$590.10. This amount was determined by totaling all the aid received by the applicant who was
not eligible.
We examined 60 Medicaid recipients 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
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
119
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2021
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)
CFDA# 93.778
Finding 2021-011 Inaccurate Resource Calculation
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of Responsible
officials and
corrective action
plans:
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 non-countable resources and explained within the documentation.
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 noncountable.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 Medicaid recipients 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.
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. Please refer to the corrective action plan for details.
120
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2021
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)
CFDA# 93.778
Finding 2021-012 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of Responsible
officials and
corrective action
plans:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
CFDA #: 93.778
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.
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.
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 21 errors discovered during our procedures that inadequate information was
requested at applications and/or redeterminations.
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)
The county agrees with the finding. Please refer to the corrective action plan for details.
SIGNIFICANT DEFICENCY: Finding 2021-009, 2021-010, 2021-011, 2021-012 also apply to State requirements and
State Awards.
Section IV. State Award Findings and Questioned Costs
We examined 60 Medicaid recipients 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.
There was no known affect to eligibility and there were no known questioned costs.
121
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2021
Views of responsible
officials:
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)
CFDA# 93.778
Finding 2021-009 IV-D Non-Cooperation
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of Responsible
officials and
corrective action
plans:
Section III. Federal Award Findings and Questioned Costs (continued)
The county agrees with the finding. Please refer to the corrective action plan for details.
This is a repeat finding from the immediate previous audit, 2020-005
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 determine eligibility. The results found or documentation made in
case notes that clearly indicates what actions were performed and the results of those actions.
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.
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.
There was 3 errors discovered during our procedures that referrals between DSS and Child
Support Agencies were not properly made.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from 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 this finding. Please refer to the corrective action plan for details.
118
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2021
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)
CFDA# 93.778
Finding 2021-010 Inaccurate Information Entry
NONCOMPLIANCE / SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of Responsible
officials and
corrective action
plans:
The county agrees with the finding. Please refer to the corrective action plan for details.
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.
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a
recipient meets specific income 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 15 errors discovered during our procedures that inaccurate information was entered
when determining eligibility. One applicant received assistance after moved out of State.
This is a repeat finding from the immediate previous audit, 2020-006
Section III. Federal Award Findings and Questioned Costs (continued)
$590.10. This amount was determined by totaling all the aid received by the applicant who was
not eligible.
We examined 60 Medicaid recipients 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
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
119
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2021
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)
CFDA# 93.778
Finding 2021-011 Inaccurate Resource Calculation
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of Responsible
officials and
corrective action
plans:
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 non-countable resources and explained within the documentation.
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 noncountable.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 Medicaid recipients 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.
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. Please refer to the corrective action plan for details.
120
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2021
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)
CFDA# 93.778
Finding 2021-012 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of Responsible
officials and
corrective action
plans:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
CFDA #: 93.778
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.
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.
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 21 errors discovered during our procedures that inadequate information was
requested at applications and/or redeterminations.
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)
The county agrees with the finding. Please refer to the corrective action plan for details.
SIGNIFICANT DEFICENCY: Finding 2021-009, 2021-010, 2021-011, 2021-012 also apply to State requirements and
State Awards.
Section IV. State Award Findings and Questioned Costs
We examined 60 Medicaid recipients 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.
There was no known affect to eligibility and there were no known questioned costs.
121