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: 2023-002 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 that inaccurate information was entered when determining
eligibility.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 370,977 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 which affect countable resource and a participant could have been approved for benefits
that they were not eligible.
This is a repeat finding from the immediate previous audit, 2022-003
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 Corrective Action Plan in the following section.
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: 2023-003
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Inaccurate Resources Entry
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 noncountable resources and explained within the documentation.
There were 7 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. Of these, one beneficiary received assistance
for which the recipient was not eligible.
The total questioned costs for the ineligibility error noted above did not meet the minimum threshold for
reporting.
We examined 60 cases from of a total of 370,977 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, 2022-004.
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 that clearly indicates what
actions were performed and the results of those actions.
The County agrees with the finding. See Corrective Action Plan in the following section.
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: 2023-004 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 and applicants 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 and 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 standards, and documentation must be maintained to support eligibility determinations. Electronic
matches are required at applications and redeterminations.
There were 5 errors discovered during our procedures that inadequate information was requested at applications
and/or redeterminations.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 370,977 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, 2022-005.
The County agrees with the finding. See Corrective Action Plan in the following section.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2023-005 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
SIGNIFICANT DEFICENCY: Finding 2023- 002, 2023-003, 2023-004, 2023-005 also apply to State requirements and State Awards.
Section IV - State Award Findings and Questioned Costs
Section III. Federal Award Findings and Questioned Costs (continued)
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 determining Medicaid eligibility.
There were 3 errors discovered during our procedures that referrals between Department of Social Services
(DSS) and Child Support Agencies were not made.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 370,977 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
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.
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: 2023-002 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 that inaccurate information was entered when determining
eligibility.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 370,977 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 which affect countable resource and a participant could have been approved for benefits
that they were not eligible.
This is a repeat finding from the immediate previous audit, 2022-003
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 Corrective Action Plan in the following section.
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: 2023-003
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Inaccurate Resources Entry
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 noncountable resources and explained within the documentation.
There were 7 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. Of these, one beneficiary received assistance
for which the recipient was not eligible.
The total questioned costs for the ineligibility error noted above did not meet the minimum threshold for
reporting.
We examined 60 cases from of a total of 370,977 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, 2022-004.
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 that clearly indicates what
actions were performed and the results of those actions.
The County agrees with the finding. See Corrective Action Plan in the following section.
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: 2023-004 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 and applicants 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 and 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 standards, and documentation must be maintained to support eligibility determinations. Electronic
matches are required at applications and redeterminations.
There were 5 errors discovered during our procedures that inadequate information was requested at applications
and/or redeterminations.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 370,977 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, 2022-005.
The County agrees with the finding. See Corrective Action Plan in the following section.
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2023-005 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
SIGNIFICANT DEFICENCY: Finding 2023- 002, 2023-003, 2023-004, 2023-005 also apply to State requirements and State Awards.
Section IV - State Award Findings and Questioned Costs
Section III. Federal Award Findings and Questioned Costs (continued)
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 determining Medicaid eligibility.
There were 3 errors discovered during our procedures that referrals between Department of Social Services
(DSS) and Child Support Agencies were not made.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 370,977 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.
The County agrees with the finding. See Corrective Action Plan in the following section.
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.