Finding Text
Hertford County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-009 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:
For those certifications/re-certifications there was a chance that information was not properly
documented and reconciled to NC FAST which could affect countable resource. Therefore, applicants
could have received assistance 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.
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 24 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 24 errors, two were 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.
We examined 60 cases from of a total of 353,314 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, 2023-010.
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. See the response in the corrective action plan.
Section III. Federal Award Findings and Questioned Costs (continued)
119