Finding Text
Vance County, North Carolina
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2024
U.S. 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 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a
repeat finding:
Recommendation:
This is a repeat finding from the immediate previous audit, 2023-010.
Section III. Federal Award Findings and Questioned Costs (continued)
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.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 830,748 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.
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.
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