Finding 1175526 (2025-001)

Finding: 2025-001 U.S. Department of Health and Human Services Passed-through N.C. Department of Health and Human Services Program Name: Medicaid Cluster AL Number: 93.778 Grant Number: XIX-MAP Program Name: Supplemental Nutrition Assistance Program AL Number: 10.561 Grant Number: 185NC406S2514 Non-Material Non-Compliance Material Weakness, Special Tests and Provisions Criteria: Per the North Carolina DSS Crosscutting Requirements compliance supplement, counties must acquire adequate case documentation to substantiate the claim entry into the Enterprise Program Integrity (EPI). This information includes but is not limited to the dates of the overpayment period, documentary evidence to substantiate that an overpayment occurred, such as wage stubs or verification from an employer, other income verification and household composition verification, and the budgets used to compute the amount of the overpayment. This also includes proper use of standardized form 1682. Condition: We noted three instances of claims entered in EPI where adequate case documentation was not maintained. Three case files did not include a signed form 1682. Context: We sampled 30 claims that were current in the EPI system and noted the above condition in nine (10%) of the claims tested. Effect: The County may not have required supporting documentation for claims entered into the EPI system. There is a risk that claims may not be valid as a result. Cause: Turnover in the department left duties unfulfilled and unsigned or missing forms in the case files. Identification of a Repeat Finding: This is a modified repeat finding from the immediate previous audit, 2024-001. Questioned Cost: The finding represents an internal control weakness; therefore, no questioned costs are applicable. Upon further review, the case was still eligible to report a claim entry into EPI. Recommendation: The County should implement controls, such as additional training and supervisory review, to ensure that all required documentation is adequate and maintained within the case file. Views of Responsible Officials and Planned Corrective Action: Management concurs with the finding. See Corrective Action Plan.