Finding Text
Effect:
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.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:
Section III - Federal Award Findings and Questioned Costs (continued)
Recommendation:
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.
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: 2024-003 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 1 errors discovered during our procedures where required
information needed for eligibility determinations were not requested or not
requested timely at applications or redeterminations.
Questioned Costs: There was no known affect to eligibility and there were no known questioned
costs.
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.
This is a repeat finding from the immediate previous audit, 2023-008.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.