Finding Text
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 2023-009 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
Eligibility
Effect: 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.
Cause: Human error in reading the ACTS report and/or ineffective case review process.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective
Action Plan.
Criteria: 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. In accordance
with 2 CFR 200, management should have an adequate system of internal controls procedures in place to ensure an
applicant is properly determined or redetermined for benefits.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-006.
Condition: There was 1 error discovered during our procedures that referrals between DSS and Child Support
Agencies were not properly made.
Condition: There were 11 errors discovered during our procedures that inaccurate
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 2023-010 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
Section III. Federal Award Findings (continued)
Criteria: 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.
Condition: There were 7 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 236,377 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.
Effect: 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.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective
Action Plan.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-008.
Recommendation: Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case notes should
clearly indicate what actions were performed and the results of those actions.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-007.