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 2023-011 Inaccurate Resources Entry
SIGNIFICANT DEFICIENCY
Eligibility
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.
Section III. Federal Award Findings (continued)
Criteria: 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.
Condition: There were 9 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.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Recommendation: 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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-009.
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.