Finding Text
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)
129
Context:
Effect:
Cause:
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
AL # 93.778
Finding: 2023-009
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Program Names: Medical Assistance
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 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.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
In accordance with the Medicaid Manual MA-3120, the State sends notification to the
County when a participant is no longer eligible under Supplemental Security Income (SSI)
determination, the County is required to initiate the ex parte review within 5 workdays of
the date the termination appears on the SSI Termination Report, and complete the
redetermination within 4 months of the month the case appears on the SSI Termination
Report and notify the recipient about applicant's ongoing eligibility for Medicaid.
There was 2 applicant/beneficiary not reviewed timely and determined to be eligible for
Medicaid when their SSI benefits were terminated, for which the recipient was not eligible.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2022-009.
Untimely Review of SSI Terminations