Criteria: 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. Condition: There were two errors discovered during our procedures that lacked appropriate ex parte reviews. Two applicants/beneficiaries received assistance for which the recipient was not eligible. Questioned Costs: These errors did effect eligibility, however the amount in claims paid in error did not rise to the level of a questioned cost. Context: We examined 120 Medicaid transactions out of 958,050 to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource and a participant could have been approved for benefits that they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-001. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participate in the review process.
Criteria: 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, documentation should be present and agree back to the records in the NC FAST system. Any items discovered in the process should be considered resources and explained within the documentation. Condition: There were forty-three (43) technical 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. The errors were as follows: Fourteen (14) cases had instances of failure to complete at least one compliance component, Nineteen (19) cases of inaccurate resource calculations in NC FAST, Nine (9) cases of inaccurate budget calculations in NC FAST, One (1) case of evidence input error. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context: We examined 138 Medicaid transactions out of 958,050 to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. Effect: For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST which affect countable resource and a participant could have been approved for benefits that they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-002. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participate in the review process.
Criteria: Food and Nutrition Services case files to require proper documentation be contained in the case record to verify eligibility. The case file should contain a completed, signed (telephonic signature is allowable) and dated Food and Nutrition Services application (DSS-8207 or electronically generated ePASS application). The form must be signed by an adult household member (or an authorized representative), and NC FAST captures the user ID which serves as the worker’s electronic signature. Additionally, employment program participation is required for specified applicants. Eligibility criteria further outlined in Food and Nutrition Services Certification Manual, Section 305 through Section 350. Condition: There were Three (3) cases lacking the required signature or date certifying the documentation, and Nine (9) cases in which the proper documentation was not provided for the client. Questioned Costs: There was no affect to eligibility and there were no questioned costs. Context: We examined 60 out of 2,676 Food and Nutrition Services case files active during the fiscal year to ensure verifications used to determine eligibility were properly documented. Effect: For the active cases, there was a chance that information was not adequately documented or were not accessible NC FAST which affect general adherence to prescribed guidelines. Identification of a repeat finding: This is not a repeat finding. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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 supporting documentation used for eligibility verification be reviewed for completeness and reconciled to the information provided in worker dictation. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support eligibility determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations. The County finance office will also participating in the review process.