Finding Text
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US 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:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
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.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
We examined 60 cases from of a total of 179,397 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 NC FAST and applicants could have been approved for benefits for
which they were not eligible.
There were 5 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.
This is a repeat finding from the immediate previous audit, 2023-003.
Section III. Federal Award Findings and Questioned Costs (continued)
This is a repeat finding from the immediate previous audit, 2023-002.
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.Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
CFDA #: 93.778
Finding: 2024-003 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Recommendation:
Section III. Federal Award Findings and Questioned Costs (continued)
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.
There were 5 errors discovered during our procedures where income or household size was
incorrectly calculated or inaccurate information was entered into the case file.
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 correct income and/or household size calculations,
proper information is included in the case file, and necessary procedures are taken when
determining eligibility. The results found or documentation made in case notes should clearly
indicate what actions were performed and the results of those actions.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 179,397 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 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 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. See Corrective Action Plan in the following section.