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: 2023-001 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
There were 7 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.
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.
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective 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, 2022-002.
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.
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.
We examined 60 cases from of a total of 1,026,673 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.
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: 2023-002 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause: Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
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.
There was 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 non-countable.
There was no known affect to eligibility and there were no known questioned
costs.
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.
Section III. Federal Award Findings and Questioned Costs (continued)
We examined 60 cases from of a total of 1,026,673 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.
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: 2023-003 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
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. Electronic matches are required at
applications and redeterminations.
There were 1 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 1,026,673 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 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.
The County agrees with the finding. Please refer to the corrective action plan for
details.
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: 2023-004 Non-cooperation with Child Support Procedures
SIGNIFICANT DEFICENCY
Criteria:
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 noncustodial
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 5 errors discovered during our procedures that referrals between
Department of Social Services (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 1,026,673 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 applicants could have
been approved for benefits for which they were not eligible.
Error in reading the 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 determining eligibility. 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 Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2023-001 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
There were 7 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.
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.
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective 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, 2022-002.
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.
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.
We examined 60 cases from of a total of 1,026,673 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.
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: 2023-002 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause: Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
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.
There was 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 non-countable.
There was no known affect to eligibility and there were no known questioned
costs.
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.
Section III. Federal Award Findings and Questioned Costs (continued)
We examined 60 cases from of a total of 1,026,673 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.
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: 2023-003 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
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. Electronic matches are required at
applications and redeterminations.
There were 1 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 1,026,673 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 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.
The County agrees with the finding. Please refer to the corrective action plan for
details.
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: 2023-004 Non-cooperation with Child Support Procedures
SIGNIFICANT DEFICENCY
Criteria:
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 noncustodial
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 5 errors discovered during our procedures that referrals between
Department of Social Services (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 1,026,673 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 applicants could have
been approved for benefits for which they were not eligible.
Error in reading the 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 determining eligibility. 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.