Finding Text
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:
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
Views of responsible officials:
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. Please refer to the corrective action plan for
details.
Section III - Federal Award Findings and Questioned Costs (continued)
Recommendation:
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.
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.
Finding: 2023-009 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
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 20 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.
Identification of a repeat finding:
Section III - Federal Award Findings and Questioned Costs (continued)
This is a repeat finding from the immediate previous audit, 2022-012.
Section IV - State Award Findings and Questioned Costs
SIGNIFICANT DEFICENCY: Finding 2023-007, 2023-008, 2023-009 also apply to State requirements and State
Awards.
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.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.