Finding 453165 (2022-002)

US Department of Health and Human ServicesPassed through the NC Department of Health and Human ServicesProgram Name: Medical Assistance Program (Medicaid; Title XIX)AL #: 93.778Finding: 2022-002 Inaccurate Information EntrySIGNIFICANT DEFICENCYEligibilityCriteria: 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.Condition: There were 7 errors discovered during our procedures that inaccurate information was entered when determining eligibility.Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.Context: We examined 60 of a total 1,085,259 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.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.Views of responsible officials and planned corrective actions: The County agrees with the finding. Please refer to the corrective action plan for details.