Finding Text
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.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:
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.
Finding: 2024-004 Non-Cooperation With Child Support Procedures
SIGNIFICANT DEFICIENCY
In accordance with the Medicaid Manual MA-3365, all Medicaid cases should
be evaluated and referred to the Child Support Enforcement Agency (IV-D). The
Child Support Enforcement Agency (IV-D) can assist the family in obtaining
financial and/or medical support or medical support payments from the child’s
non-custodial parent. Cooperation requirement with Social Services and Child
Support Agencies must be met or good cause for not cooperating must be
established when determining Medicaid eligibility.
There were 1 errors discovered during our procedures that referrals between
DSS and Child Support Agencies were not properly made.
Questioned Costs: 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.