CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2023
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: 2023-013 IV-D Non-Cooperation
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
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 were 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 of a total of 229,178 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.
Section III. Federal Award Findings and Questioned Costs (continued)
This is a repeat finding from the immediate previous audit, 2022-012
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.
126
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2023
Views of Responsible
officials and corrective
action plans:
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: 2023-014 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
Cause:
Recommendation:
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.
We examined 60 cases from of a total of 229,178 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.
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.
This is a repeat finding from the immediate previous audit, 2022-013
Section III. Federal Award Findings and Questioned Costs (continued)
There was no known affect to eligibility and there were no known questioned costs.
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 2 errors discovered during our procedures that inaccurate information was entered
when determining eligibility.
127
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2023
Views of Responsible
officials and corrective
action plans:
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: 2023-015 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
Cause:
We examined 60 cases from of a total of 229,178 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.
There was no known affect to eligibility and there were no known questioned costs.
Section III. Federal Award Findings and Questioned Costs (continued)
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 11 errors discovered during our procedures that inadequate information was
requested at applications and/or redeterminations.
The county agrees with the finding. Please refer to the corrective action plan for details.
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, 2022-014
128
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2023
Recommendation:
Views of Responsible
officials and corrective
action plans:
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: 2023-016 Inaccurate Resource Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Section III. Federal Award Findings and Questioned Costs (continued)
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 cases from of a total of 229,178 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.
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.
129CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2023
Cause:
Recommendation:
Views of Responsible
officials and corrective
action plans:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
N.C. Department of Commerce
Program Name: Building Reuse Program
Finding: 2023-017 Lack of Internal Control Procedures Over State Programs
SIGNIFICANT DEFICIENCY
Activities Allowed or Unallowed, Allowable Costs/Cost Principles
Criteria:
Condition:
Effect:
Section III. Federal Award Findings and Questioned Costs (continued)
In accordance with the Uniform Guidance, the County is reponsible for establishing and
maintaining effective internal control over compliance with the types of compliance
requirements that could have direct and material effect on a major state program.
The County did not receive supporting documents from the property owner to ensure the grant
fund was used for allowed activities and costs when the property owner requesting the grant
fund, and there were no effective internal control procedures in place to detect or correct this
issue.
The grant fund could be used for unallowed activities and costs.
SIGNIFICANT DEFICENCY: Findings 2023-013, 2023-014, 2023-015, 2023-016 also apply to State requirements and
State Awards.
Section IV. State Award Findings and Questioned Costs
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.
130
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2023
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: 2023-013 IV-D Non-Cooperation
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
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 were 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 of a total of 229,178 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.
Section III. Federal Award Findings and Questioned Costs (continued)
This is a repeat finding from the immediate previous audit, 2022-012
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.
126
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2023
Views of Responsible
officials and corrective
action plans:
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: 2023-014 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
Cause:
Recommendation:
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.
We examined 60 cases from of a total of 229,178 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.
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.
This is a repeat finding from the immediate previous audit, 2022-013
Section III. Federal Award Findings and Questioned Costs (continued)
There was no known affect to eligibility and there were no known questioned costs.
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 2 errors discovered during our procedures that inaccurate information was entered
when determining eligibility.
127
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2023
Views of Responsible
officials and corrective
action plans:
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: 2023-015 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
Cause:
We examined 60 cases from of a total of 229,178 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.
There was no known affect to eligibility and there were no known questioned costs.
Section III. Federal Award Findings and Questioned Costs (continued)
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 11 errors discovered during our procedures that inadequate information was
requested at applications and/or redeterminations.
The county agrees with the finding. Please refer to the corrective action plan for details.
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, 2022-014
128
CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2023
Recommendation:
Views of Responsible
officials and corrective
action plans:
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: 2023-016 Inaccurate Resource Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Section III. Federal Award Findings and Questioned Costs (continued)
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 cases from of a total of 229,178 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.
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.
129CASWELL COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2023
Cause:
Recommendation:
Views of Responsible
officials and corrective
action plans:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
N.C. Department of Commerce
Program Name: Building Reuse Program
Finding: 2023-017 Lack of Internal Control Procedures Over State Programs
SIGNIFICANT DEFICIENCY
Activities Allowed or Unallowed, Allowable Costs/Cost Principles
Criteria:
Condition:
Effect:
Section III. Federal Award Findings and Questioned Costs (continued)
In accordance with the Uniform Guidance, the County is reponsible for establishing and
maintaining effective internal control over compliance with the types of compliance
requirements that could have direct and material effect on a major state program.
The County did not receive supporting documents from the property owner to ensure the grant
fund was used for allowed activities and costs when the property owner requesting the grant
fund, and there were no effective internal control procedures in place to detect or correct this
issue.
The grant fund could be used for unallowed activities and costs.
SIGNIFICANT DEFICENCY: Findings 2023-013, 2023-014, 2023-015, 2023-016 also apply to State requirements and
State Awards.
Section IV. State Award Findings and Questioned Costs
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.
130