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 DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
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.
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 585,921 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
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, 2022-002.
Section III - Federal Award Findings and Questioned Costs
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 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:
Section III. Federal Award Findings and Questioned Costs (continued)
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 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.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 585,921 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
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.
This is a repeat finding from the immediate previous audit, 2022-003.
155
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:
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. 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.
This is a repeat finding from the immediate previous audit, 2022-004.
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. See Corrective Action Plan in the following
section.
We examined 60 cases from of a total of 585,921 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
Section III. Federal Award Findings and Questioned Costs (continued)
156
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 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
We examined 60 cases from of a total of 585,921 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement
audit as it relates to Medicaid administrative cost compliance audit.
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 2 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.
The County agrees with the finding. See Corrective Action Plan in the following
section.
This is a repeat finding from the immediate previous audit, 2022-005.
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.
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 Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2023-001 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
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.
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 585,921 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
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, 2022-002.
Section III - Federal Award Findings and Questioned Costs
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 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:
Section III. Federal Award Findings and Questioned Costs (continued)
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 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.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 585,921 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
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.
This is a repeat finding from the immediate previous audit, 2022-003.
155
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:
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. 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.
This is a repeat finding from the immediate previous audit, 2022-004.
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. See Corrective Action Plan in the following
section.
We examined 60 cases from of a total of 585,921 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
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.
Section III. Federal Award Findings and Questioned Costs (continued)
156
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 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
We examined 60 cases from of a total of 585,921 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement
audit as it relates to Medicaid administrative cost compliance audit.
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 2 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.
The County agrees with the finding. See Corrective Action Plan in the following
section.
This is a repeat finding from the immediate previous audit, 2022-005.
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.
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.