Finding Text
Cause:
Recommendation:
Views of responsible
officials and planned
corrective 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: 2023-008 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
The County agrees with the finding. See the response in the corrective action plan.
There were 4 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
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.
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.
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.
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, 2022-009.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
Cause:
Recommendation:
Views of responsible
officials and planned
corrective 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: 2023-009 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
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.
Section III. Federal Award Findings and Questioned Costs (continued)
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance 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.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
The County agrees with the finding. See the response in the corrective action plan.
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.
There were 5 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 305,518 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, 2022-010.