US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program
CFDA #: 93.778
Finding: 2022-008 SSI Terminations
SIGNIFICANT DEFICIENCY
Eligibility
Criteria: In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid.
Condition: There was 1 error in which a beneficiary was not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 43,722 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.
Identification of a Effect: The County did not initiate an ex-parte review timely, therefore, no eligibility review was completed in the required time period. The lack of follow up and certification lead to applicants receiving Medicaid benefits for which they were not eligible.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-008.
Cause: Ineffective communication between departments within the Department of Social Services. One area within DSS received State communications that applicants would no longer be eligible for SSI benefits and the County needed to conduct an application process. This information was not shared with other departments in DSS from which the recipient was also receiving benefits.
Recommendation: Any State communications related to applicants’ benefits received by any DSS department should be shared with all areas from which the participant receives benefits. State files should be reviewed internally to ensure all actions have been properly closed and the corrective action has been taken. Workers should be retrained on what process needs to be followed when State communications are received.
Views of responsible officials: 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
CFDA #: 93.778
Finding: 2022-009 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria: 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.
Condition: There were 11 errors discovered during our procedures that inaccurate information was entered when determining eligibility.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 43,722 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.
Identification of a Effect: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-009.
Cause: Ineffective communication between departments within the Department of Social Services. One area within DSS received State communications that applicants would no longer be eligible for SSI benefits and the County needed to conduct an application process. This information was not shared with other departments in DSS from which the recipient was also receiving benefits.
Recommendation: Any State communications related to applicants’ benefits received by any DSS department should be shared with all areas from which the participant receives benefits. State files should be reviewed internally to ensure all actions have been properly closed and the corrective action has been taken. Workers should be retrained on what process needs to be followed when State communications are received.
Views of responsible officials: 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
CFDA #: 93.778
Finding: 2022-010 Inaccurate Resource Calculation
SIGNIFICANT DEFICIENCY
Eligibility
Criteria: 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 non-countable resources and explained within the documentation.
Condition: There were 9 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.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 43,722 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.
Identification of a Effect: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-010.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.
Views of responsible officials: 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
CFDA #: 93.778
Finding: 2022-011 IV-D Child Support Non-Cooperation
SIGNIFICANT DEFICIENCY
Eligibility
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 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.
Condition: There was 1 error in which a beneficiary was not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 43,722 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.
Identification of a Effect: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-011.
Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process.
Recommendation: 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.
Views of responsible officials: 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
CFDA #: 93.778
Finding: 2022-012 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
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.
Condition: There were 7 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 43,722 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.
Identification of a Effect: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-012.
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 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.
Views of responsible officials: 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
CFDA #: 93.778
Finding: 2022-008 SSI Terminations
SIGNIFICANT DEFICIENCY
Eligibility
Criteria: In accordance with the Medicaid Manual MA-3120, the State sends notification to the County when a participant is no longer eligible under Supplemental Security Income (SSI) determination, the County is required to initiate the ex parte review within 5 workdays of the date the termination appears on the SSI Termination Report, and complete the redetermination within 4 months of the month the case appears on the SSI Termination Report and notify the recipient about applicant's ongoing eligibility for Medicaid.
Condition: There was 1 error in which a beneficiary was not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 43,722 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.
Identification of a Effect: The County did not initiate an ex-parte review timely, therefore, no eligibility review was completed in the required time period. The lack of follow up and certification lead to applicants receiving Medicaid benefits for which they were not eligible.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-008.
Cause: Ineffective communication between departments within the Department of Social Services. One area within DSS received State communications that applicants would no longer be eligible for SSI benefits and the County needed to conduct an application process. This information was not shared with other departments in DSS from which the recipient was also receiving benefits.
Recommendation: Any State communications related to applicants’ benefits received by any DSS department should be shared with all areas from which the participant receives benefits. State files should be reviewed internally to ensure all actions have been properly closed and the corrective action has been taken. Workers should be retrained on what process needs to be followed when State communications are received.
Views of responsible officials: 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
CFDA #: 93.778
Finding: 2022-009 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria: 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.
Condition: There were 11 errors discovered during our procedures that inaccurate information was entered when determining eligibility.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 43,722 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.
Identification of a Effect: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-009.
Cause: Ineffective communication between departments within the Department of Social Services. One area within DSS received State communications that applicants would no longer be eligible for SSI benefits and the County needed to conduct an application process. This information was not shared with other departments in DSS from which the recipient was also receiving benefits.
Recommendation: Any State communications related to applicants’ benefits received by any DSS department should be shared with all areas from which the participant receives benefits. State files should be reviewed internally to ensure all actions have been properly closed and the corrective action has been taken. Workers should be retrained on what process needs to be followed when State communications are received.
Views of responsible officials: 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
CFDA #: 93.778
Finding: 2022-010 Inaccurate Resource Calculation
SIGNIFICANT DEFICIENCY
Eligibility
Criteria: 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 non-countable resources and explained within the documentation.
Condition: There were 9 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.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 43,722 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.
Identification of a Effect: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-010.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility.
Views of responsible officials: 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
CFDA #: 93.778
Finding: 2022-011 IV-D Child Support Non-Cooperation
SIGNIFICANT DEFICIENCY
Eligibility
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 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.
Condition: There was 1 error in which a beneficiary was not reviewed timely and determined to be eligible for Medicaid when their SSI benefits were terminated.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 43,722 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.
Identification of a Effect: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-011.
Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process.
Recommendation: 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.
Views of responsible officials: 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
CFDA #: 93.778
Finding: 2022-012 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
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.
Condition: There were 7 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 43,722 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.
Identification of a Effect: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-012.
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 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.
Views of responsible officials: The county agrees with the finding. Please refer to the corrective action plan for details.