Finding Text
U.S. 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: 2023-012 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a repeat
finding:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
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
There were 7 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 804,789 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.
Section IV. State Award Findings and Questioned Costs
This is a repeat finding from the immediate previous audit, 2022-008.
SIGNIFICANT DEFICENCY: Finding 2023-008, 2023-009, 2023-010, 2023-011, 2023-012 also apply to State
requirements and State Awards.
Section III. Federal Award Findings and Questioned Costs (continued)
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.