Finding Text
Nash County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-003 Inaccurate Resources Entry
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
We examined 60 cases from a total of 1,168,444 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.
Ineffective record keeping and ineffective case review process, incomplete documentation, and
incorrect application of rules for purposes of determining eligibility.
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 non-countable
resources and explained within the documentation.
There were no known affects to eligibility and there were no known questioned costs.
The County agrees with the finding and is implementing actions to correct these issues, which are
further discussed in the corrective action plan.
This is a repeat finding from the immediate previous audit, 2023-003.
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.
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.
This is a repeat finding from the immediate previous audit, 2023-002.
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 and a participant could have been approved for benefits 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.
186Nash County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
Recommendation:
Views of responsible officials
and planned corrective
actions:
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medicaid Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2024-004 IV-D Cooperation with Child Support
SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible officials
and planned corrective
actions:
There were 3 errors discovered during our procedures that referrals between DSS and Child Support
Agencies were not properly made.
There were no known affects to eligibility and there were no known questioned costs.
The County agrees with the finding and is implementing actions to correct these issues, which are
further discussed in the corrective action plan.
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.
In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and
referred to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency
(IV-D) can assist the family in obtaining financial and/or medical support or medical support
payments from the child’s non-custodial parent. Cooperation requirement with Social Services and
Child Support Agencies must be met or good cause for not cooperating must be established when
determining Medicaid eligibility.
We examined 60 cases from a total of 1,168,444 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 applicants could have been approved for benefits for
which they were not eligible.
Section III - Federal Award Findings and Questioned Costs (Continued)
The County agrees with the finding and is implementing actions to correct these issues, which are
further discussed in the corrective action plan.
This is a repeat finding from the immediate previous audit, 2023-004.
Human error in reading the Automated Collection and Tracking System (ACTS) report and/or
ineffective case review process.
Files should be reviewed internally to ensure proper information is in place and necessary
procedures are taken when determine eligibility. The results found or documentation made in case
notes should clearly indicate what actions were performed and the results of those actions.
187