Finding Text
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program
AL #: 93.778
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Context:
Effect:
Identification of a repeat finding:
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.
Recommendation: The County should allocate sufficient resources to ensure that all records are
reconciled timely to allow time for the audit to be completed timely.
Views of responsible officials: The County agrees with this finding. Please refer to the corrective action plan
for details.
Finding: 2023-007
There were 7 errors discovered during our procedures that inaccurate
information was entered when determining eligibility.
Questioned Cost:
The County's audits have been submitted late over the past several years. The
County was unable to provide information necessary to complete the audit
timely as a result of staffing issues.
There was no known affect to eligibility and there were no known questioned
costs.
We examined 60 cases from of a total of 40,658 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, 2022-007.
Inaccurate Information Entry
This is a repeat finding from the immediate previous audit, 2022-009.
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.
Cause:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program
AL #: 93.778
Eligibility
Criteria:
Condition:
Context:
Effect:
Identification of a repeat finding:
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 was no known affect to eligibility and there were no known questioned
costs.
Inaccurate Resource Calculation
Section III - Federal Award Findings and Questioned Costs (continued)
Finding: 2023-008
SIGNIFICANT DEFICIENCY
Questioned Costs:
This is a repeat finding from the immediate previous audit, 2022-010.
There were 8 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.
We examined 60 cases from of a total of 40,658 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.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
Views of responsible officials:
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.
The county agrees with the finding. Please refer to the corrective action plan for
details.