Finding Text
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: 2023-003
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
Inaccurate Resources Entry
In accordance with Medicaid Manual MA-2230, 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, the countable resources should be calculated correctly and agree
back to the amounts in the NC FAST system. Any items discovered in the verification process should be
considered countable or noncountable resources and explained within the documentation.
There were 7 errors discovered during our procedures that resources in the county documentation and those
same resources contained in NC FAST were not the same amounts or files containing resources were not
properly documented to be considered countable or non-countable. Of these, one beneficiary received assistance
for which the recipient was not eligible.
The total questioned costs for the ineligibility error noted above did not meet the minimum threshold for
reporting.
We examined 60 cases from of a total of 370,977 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 a participant could have been approved for benefits for which they were not eligible.
This is a repeat finding from the immediate previous audit, 2022-004.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
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 that clearly indicates what
actions were performed and the results of those actions.
The County agrees with the finding. See Corrective Action Plan in the following section.