Finding 515839 (2024-004)

US Department of Health and Human Service Passed through the NC Dept of Health and Human Services Finding: 2024-004 SIGNIFICANT DEFICIENCY Eligibility Criteria: Condition: Context: Effect: Cause: Section III - Federal Award Findings and Questioned Costs (continued) There were 7 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. Of these 7 errors, one was determined to be an eligibility error with known questioned costs. As a result of the lack of a proper eligibility determination, federal funds were distributed to ineligible recipients leading to known questioned costs totaling $663. This may result in disallowed costs that will need to be repaid to the federal awarding agency. Questioned Costs: We examined 60 cases from of a total of 373,631 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 which could affect countable resource. Therefore, a participant could have been approved to receive benefits for which they were not eligible. 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-007. 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. Program Names: Medical Assistance AL # 93.778 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.