Finding Text
Criteria: 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. documentation should he present and agree back to the records in the NC FAST system. Any Items discovered In the process should be considered resources and explained within the documentation.
Condition: There were eleven (11) technical errors discovered during our procedures that resoum,s ill th• county documentation and those same resources contalned in NC FAST were not the same amounts or files containing resources were not properly documei1ted to be considered countable or non-countable. The errors were as follows: Three (3) rases had a failure to complete at least one compliance component or were improperly forced, two (2) cases lacked substantiating documentation and/or inaccurate resource calculations, four (4) cases did not have accurate budget calculations, and two {2) cases had Inaccurate needs t1nit calculations.
Questioned Costs, There was no affect to eligibility and there were no questioned costs.
Context: We examined 60 Medkald transactions out of 442,357 to re-determine eligibility Medicaid daims from the Medicaid beneficiary report provided by the NC Department of Health and Human Services. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Servicesand are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit.
Effect: Por those certifications/re•certilications there was a chance that information was not properly documented and reconciled to NC PAST which affect countable resource and a participant could have been approved for benefits that they were not eligible.
Cause: Ineffective record keeping and ineffective case review process, Incomplete documentation, and incorrect application ofrutes for purposes of determining eligibility.
ldentlficallon ora repeat finding, This is a repeat finding from the Immediate previous audit, 2023-001.
Recommendation: Flies should be reviewed internally to ensure proper documentation is in place for eligiblllty. Worlrors should he retrained on what files should contain and the Importance of complete and accurate record keeping. We recommend that all files Include online verifications, dornmented resources of Income and those amounts agree to information in NC FAST.
Views ofrespouslble officials and planned corrective actions: The County agrees with the finding. Supervisors will perform second party reviews to ensure proper documentation is contained in files to support ellglblllty determinations. Workers will be retrained on what information should be maintained in case files, the importance of complete and accurate record keeping, and reserve calculations.