Finding Text
Scotland 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: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2024-002 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Identification of a repeat
finding:
Effect:
Cause:
Recommendation:
Section III. Federal Award Findings and Questioned Costs
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 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 2 errors discovered during our procedures where resources were imcorrectly calculated
or were not properly documented in the case file. Of these 2 errors, one was determined to be an
eligibility error with potential questioned costs.
There was no known affect to eligibility and there were no known questioned costs.
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, or
incorrect application of rules for purposes of determining eligibility.
We examined 60 from a total of 623,126 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.
This is a repeat finding from the immediate previous audit, 2023-005.
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