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: 2024-001 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
Section III. Federal Award Findings and Questioned Costs
Section I. Summary of Auditors' Results (continued)
Section II. Financial Statement Findings
Type of auditors' report issued on compliance for major State programs:
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.
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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: 2024-002 Inadequate Request For Information
SIGNIFICANT DEFICENCY
ELIGIBILITY
Criteria:
Section III. Federal Award Findings and Questioned Costs (continued)
There were 7 errors discovered during our procedures where income or household size
was incorrectly calculated or inaccurate information was entered into the case file.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 1,176,385 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, 2023-001.
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.