Finding 399043 (2023-006)

Context: Effect: Cause: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2023-006 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-006. Section III - Federal Award Findings and Questioned Costs (continued) Views of Responsible Officials and Planned Corrective Actions: The county agrees with this finding. See corrective action plan. Program Names: Medical Assistance AL # 93.778 IV-D Non-Cooperation In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial parent. Cooperation requirement with Social Services and Child Support Agencies must be met or good cause for not cooperating must be established when determining Medicaid eligibility. For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and applicants could have been approved for benefits for which they were not eligible. We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. 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 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. Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. There were 2 errors discovered during our procedures that referrals between DSS and Child Support Agencies were not properly made. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. 127 Context: Effect: Cause: US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2023-007 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: AL # 93.778 Inaccurate Information Entry In accordance with 42 CFR 435, documentation must be obtained as needed to determine if a recipient meets specific income 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. There were 8 errors discovered during our procedures that inaccurate information was entered when determining eligibility. One applicant received assistance although the family income were above the State provided income Standard. There was no known affect to Questioned Costs: eligibility and there were no known questioned costs. We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine eligibility. These findings are being reported with the financial statement audit as it relates to Medicaid administrative cost compliance audit. 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. Section III - Federal Award Findings and Questioned Costs (continued) We examined 60 cases from of a total of 331,466 Medicaid claims from the Medicaid beneficiary report provided by NC Department of Health and Human Services to redetermine 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 North Carolina Families Accessing Services through Technology (NC FAST) and a participant could have been approved for benefits for which they were not eligible. Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case review process. Program Names: Medical Assistance Views of Responsible Officials and Planned Corrective Actions: The County agrees with the finding. See corrective action plan. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-007.