Finding 1099838 (2024-003)

Burke County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2024 Condition: Questioned Costs: Context: Effect: 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: 2024-003 Inadequate Request For Information SIGNIFICANT DEFICENCY ELIGIBILITY Criteria: Condition: The County agrees with the finding. See Corrective Action Plan in the following section. 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 2 errors discovered during our procedures where required information needed for eligibility determinations were not requested or not requested timely at applications or redeterminations. Section III. Federal Award Findings and Questioned Costs (continued) There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 1,076,004 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. Case files should be reviewed internally to ensure correct calculations of resources are made, 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 were 5 errors discovered during our procedures where resources were imcorrectly calculated or were not properly documented in the case file. 132Burke County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2024 Questioned Costs: Context: Effect: Cause: Recommendation: Views of responsible officials and planned corrective actions: There was no known affect to eligibility and there were no known questioned costs. We examined 60 cases from of a total of 1,076,004 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. 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 all required verifications have been completed and information requested from the applicant/beneficiary or through various systems have been included 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. The County agrees with the finding. See Corrective Action Plan in the following section. Section III. Federal Award Findings and Questioned Costs (continued) 133