Finding Text
Vance County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
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 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a
repeat finding:
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
The County agrees with the finding. See Corrective Action Plan in the following
section.
We examined 60 cases from of a total of 830,748 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.
There were 14 errors discovered during our procedures where required information
needed for eligibility determinations were not requested or not requested timely at
applications or redeterminations. Of these 14 errors, one was determined to be an
eligibility error with potential questioned costs.
As a result of the lack of a proper eligibility determination, federal funds were
distributed to ineligible recipients. Due to the nature of these types of eligibility
determinations and the lack of a proper review by the department, the auditor is
unable to determine the known or likely questioned costs.
This is a repeat finding from the immediate previous audit, 2023-012.
Section III. Federal Award Findings and Questioned Costs (continued)
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.
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