Finding 524318 (2024-009)

Northampton County, North Carolina Schedule of Findings and Questioned Costs For the Year Ended June 30, 2024 US 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 2024-009 Inaccurate Information Entry SIGNIFICANT DEFICIENCY Eligibility Section III – Federal Award Findings and Questioned Costs (continued) Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective Action Plan. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Recommendation: 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. Criteria: 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2023-009. Condition: There were 5 errors discovered during our procedures where income or household size was incorrectly calculated or inaccurate information was entered into the case file. Of these 5 errors, one was determined to be an eligibility error with known questioned costs. 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 $2,010. This may result in disallowed costs that will need to be repaid to the state or federal awarding agency. Context: We examined 60 cases from of a total of 262,448 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. Effect: 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. 143