Finding Text
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL# 93.778
Finding: 2023-002 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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.
There were 3 errors discovered during our procedures that inaccurate information was entered when determining
eligibility.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 370,977 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 which affect countable resource and a participant could have been approved for benefits
that they were not eligible.
This is a repeat finding from the immediate previous audit, 2022-003
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 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.
The County agrees with the finding. See Corrective Action Plan in the following section.