Finding Text
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: 2023-002 Inaccurate Resources 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:
This is a repeat finding from the immediate previous audit, 2022-003.
We examined 60 cases from of a total of 175,350 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.
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.
The County agrees with the finding.