Finding Text
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: 2024-001 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
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.
There were 7 errors discovered during our procedures that inaccurate information was entered when determining
eligibility.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 401,179 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.
For those certifications/re-certifications there was a chance that information was not properly documented and
reconciled to NC FAST which affect countable resource and a participant could have been approved for benefits
that they were not eligible.
This is a repeat finding from the immediate previous audit, 2023-002
Section III - Federal Award Findings and Questioned Costs
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
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: 2024-002 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
The County agrees with the finding. See Corrective Action Plan in the following section.
The total questioned costs for the ineligibility error noted above did not meet the minimum threshold for reporting.
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.
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.
Section III - Federal Award Findings and Questioned Costs (continued)
The County agrees with the finding. See Corrective Action Plan in the following section.
Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
This is a repeat finding from the immediate previous audit, 2023-003.
We examined 60 cases from of a total of 401,179 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.
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.
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 were 4 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. Of these, one beneficiary received assistance for which
the recipient was not eligible.