Finding Text
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.
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
AL # 93.778
Finding: 2023-008
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
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 that clearly indicates
what actions were performed and the results of those actions.
The County agrees with the finding. See corrective action plan.
For those certifications/re-certifications there was a chance that information was not
properly documented and reconciled to NC FAST which could affect countable resource.
Therefore, a participant could have been approved to receive benefits for which they were
not eligible.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-008.
Program Names: Medical Assistance
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 was 1 error 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.
Views of Responsible
Officials and Planned
Corrective Actions:
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
Inaccurate Resource Calculation
Questioned Costs: The total questioned costs for the ineligibility error noted above did not meet the minimum
threshold for reporting.
Section III - Federal Award Findings and Questioned Costs (continued)
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