CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2022
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2022-012 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:
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 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 260,208 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, 2021-009
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.
The county agrees with the finding. Please refer to the corrective action plan for details.
Section III. Federal Award Findings and Questioned Costs (continued)
127
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2022
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2022-013 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:
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.
This is a repeat finding from the immediate previous audit, 2021-010.
Section III. Federal Award Findings and Questioned Costs (continued)
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 260,208 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. 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 10 errors discovered during our procedures that inaccurate information was entered
when determining eligibility. One applicant received assistance after moved out of State.
128
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2022
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2022-014 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of Responsible
officials and
corrective action
plans:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 260,208 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. Please refer to the corrective action plan for details.
SIGNIFICANT DEFICENCY: Findings 2022-012, 2022-013, 2022-014 also apply to State requirements and State
Awards.
This is a repeat finding from the immediate previous audit, 2021-012.
Section IV. State Award Findings and Questioned Costs
Section III. Federal Award Findings and Questioned Costs (continued)
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 3 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.
129
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2022
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2022-012 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:
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 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 260,208 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, 2021-009
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.
The county agrees with the finding. Please refer to the corrective action plan for details.
Section III. Federal Award Findings and Questioned Costs (continued)
127
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2022
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2022-013 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:
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.
This is a repeat finding from the immediate previous audit, 2021-010.
Section III. Federal Award Findings and Questioned Costs (continued)
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 260,208 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. 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 10 errors discovered during our procedures that inaccurate information was entered
when determining eligibility. One applicant received assistance after moved out of State.
128
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2022
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2022-014 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of Responsible
officials and
corrective action
plans:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 260,208 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. Please refer to the corrective action plan for details.
SIGNIFICANT DEFICENCY: Findings 2022-012, 2022-013, 2022-014 also apply to State requirements and State
Awards.
This is a repeat finding from the immediate previous audit, 2021-012.
Section IV. State Award Findings and Questioned Costs
Section III. Federal Award Findings and Questioned Costs (continued)
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 3 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.
129