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:
Section II - Financial Statement Findings
Section I - Summary of Auditors' Results (continued)
Section III - Federal Award Findings and Questioned Costs
Finding: 2024-001 Inaccurate Information Entry
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.
There were 3 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 a total of 46,508 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.
Questioned Cost:
151Effect:
Identification of a repeat finding:
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:
We examined 60 cases from a total of 46,508 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:
This is a repeat finding from the immediate previous audit 2023-007.
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.
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: 2024-002
SIGNIFICANT DEFICIENCY
Questioned Costs:
There were 1 errors discovered during our procedures where resources were
imcorrectly calculated or were not properly documented in the case file.
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.
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.