Finding Text
LEE COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
US Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-006
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
importance of complete and accurate record keeping. We recommend that all files
include online verifications, documented resources and 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 Corrective Action Plan in the following
section.
Untimely Review of SSI Terminations
In accordance with the Medicaid Manual MA-3120, the State sends notification to
the County when a participant is no longer eligible under a SSI determination. The
County has a certain time period to initiate an ex-parte review to determine whether
the recipient qualifies for Medicaid under any other coverage group, such as Family
and Children's Medicaid, North Carolina Health Choice for Children, Work First
Family Assistance, or Medicaid for the Aged, Blind and Disabled.
There were 1 applicants/beneficiaries not reviewed timely and determined to be
eligible for Medicaid when their SSI benefits were terminated.
There was no known effect to eligibility and there were no known questioned costs.
We examined 60 cases from a total of 708,144 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 applicants could have been
approved for benefits for which they were not eligible.
This is a repeat finding from the immediate previous audit, 2023-003.
Ineffective record keeping and ineffective case review process, incomplete
documentation, and incorrect application of rules for purposes of determining
eligibility.
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
Section III. Federal Award Findings and Questioned Costs (continued)
166LEE COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Context:
Effect:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
Finding: 2024-007 Funds Management
SIGNIFICANT DEFICIENCY
Cash Management
Criteria:
Condition:
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
SIGNIFICANT DEFICIENCY: Finding 2024-003, 2024-004, 2024-005, 2024-006 also apply to State requirements
and State Awards.
N.C. Office of State Budget and Management
Program Name: Office of State Budget and Management - Special Appropriation
In accordance with North Carolina General Statute (G.S.) 143C-6-23 and the grant
contract with North Carolina Office of State Budget and Management, the grant
funds should be accounted for in a separate fund and accounting structure within the
recipient's central accounting and/or grant management system.
The grant funds were accounted for in County General Fund instead of a separate
fund.
The County agrees with the finding. See Corrective Action Plan in the following
section.
Section IV - State Award Findings and Question Costs
Section III. Federal Award Findings and Questioned Costs (continued)
has been taken. Workers should be retrained on what process needs to be followed
when State communications are received.
We examined 60 cases from a total of 708,144 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.
The County did not initiate ex-parte review timely, therefore, no eligibility review
was completed in the required time period. The lack of follow up and certification
lead to applicants receiving Medicaid benefits for which they were not eligible.
Ineffective communication between departments within the Department of Social
Services. One area within DSS received State communications that applicants would
no longer be eligible for SSI benefits and the County needed to conduct an ex-parte
review. This information was not shared with other departments in DSS from which
the recipient was also receiving benefits.
Any State communications related to applicants/beneficiaries should be shared with
all areas from which the participant receives benefits. State files should be reviewed
internally to ensure all actions have been properly closed and the corrective action
167