Finding Text
Richmond County
Schedule of Findings and Questioned Costs
For The Year Ended June 30, 2024
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
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: 2024-007 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
This is a repeat finding from the immediate previous audit, 2023-006.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 826,901 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 toRichmond County
Schedule of Findings and Questioned Costs
For The Year Ended June 30, 2024
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: 2024-008 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
We examined 60 cases from of a total of 826,901 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.
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 NC FAST and applicants could have been approved for benefits for which they were not eligible.
Section III - Federal Award Findings and Questioned Costs (continued)
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.
The County agrees with the finding. See Corrective Action Plan in the following section.
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.
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.
There was no known affect to eligibility and there were no known questioned costs.
136 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 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.
This is a repeat finding from the immediate previous audit, 2023-005.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
The County agrees with the finding. See Corrective Action Plan in the following section.
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.
There were 6 errors discovered during our procedures where resources were incorrectly calculated or were not
properly documented in the case file.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 826,901 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.
135