Finding Text
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-009 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
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)
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, applicants
could have received assistance 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.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
The County agrees with the finding. See the response in the corrective action plan.
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.
There were 5 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.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.
This is a repeat finding from the immediate previous audit, 2022-010.
Recommendation:
Views of responsible
officials and planned
corrective actions:
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-010 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a
repeat finding:
Cause:
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.
The County agrees with the finding. See the response in the corrective action plan.
This is a repeat finding from the immediate previous audit, 2022-011.
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)
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, applicants
could have received assistance 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.
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.
Electronic matches are required at applications and redeterminations.
There were 24 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 305,518 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.