Finding Text
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2023-006 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2023-007 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
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.
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 should clearly indicate
what actions were performed and the results of those actions.
The County agrees with the finding. See Corrective Action Plan in the following section.
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 4 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
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 non-countable resources and explained within the documentation.
There were 5 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.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 754,993 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.
Section III - Federal Award Findings and Questioned Costs (continued)
This is a repeat finding from the immediate previous audit, 2022-007.
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Food and Nutrition Services (FNS) Cluster
AL # 10.551 and 10.561
Finding: 2023-008 Inaccurate Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
This is a repeat finding from the immediate previous audit, 2022-009.
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 and 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 Corrective Action Plan in the following section.
There was no known affect to eligibility and there were no known questioned costs.
For those certifications/re-certifications there was a chance that information was not properly documented and
reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible.
Section III - Federal Award Findings and Questioned Costs (continued)
Per Section 200.303 of the Uniform Grant Guidance, a non-federal entity must establish and maintain effective
internal control over the Federal award that provides reasonable assurance that the non-federal entity is
managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of
the Federal award. The State has provided policies and procedures to ensure that the County is meeting the
federal guidance, relevant policies are:
Food and Nutrition Services Policy 305 describes the verification sources and requirements and the FNS units
primary responsibility for providing documentary evidence to support statements on applications and
recertifications and procedures required if the statements by applicant/beneficiary are questionable.
Food and Nutrition Services Policy 300 describes the sources of income countable and not countable to the
household for determining financial eligibility.
Food and Nutrition Services Policy 310 describes the procedures related to verifying changes in income (i.e.
termination, end of contract, temporary, etc.).
We examined 60 cases from of a total of 754,993 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.