Finding 1150184 (2023-015)

CASWELL COUNTY, NORTH CAROLINA Schedule of Findings and Questioned Costs For the Year Ended June 30, 2023 Views of Responsible officials and corrective action plans: US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medicaid Assistance Program (Medicaid; Title XIX) AL# 93.778 Finding: 2023-015 Inadequate Request for Information SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Questioned Costs: Context: Effect: Identification of a repeat Cause: We examined 60 cases from of a total of 229,178 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. There was no known affect to eligibility and there were no known questioned costs. Section III. Federal Award Findings and Questioned Costs (continued) For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. 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 11 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. The county agrees with the finding. Please refer to the corrective action plan for details. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. This is a repeat finding from the immediate previous audit, 2022-014 128