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: 2023-005 Inaccurate Information Entry
SIGNIFICANT DEFICIENCY
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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-003.
Effect: For those certifications/re-certifications there was a chance that information was not properly documented
and reconciled to North Carolina Families Accessing Services through Technology (NC FAST) and a participant
could have been approved for benefits for which they were not eligible.
Cause: Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective
case review process.
Section III. Federal Award Findings
Criteria: In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred
to the Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the
family in obtaining financial and/or medical support or medical support payments from the child’s non-custodial
parent. Cooperation requirement with Department of Social Services (DSS) and Child Support Agencies must be
met or good cause for not cooperating must be established when determine Medicaid eligibility.
Condition: There were 4 errors discovered during our procedures that referrals between the County's Department
of Social Services and Child Support Agencies were not properly made.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 from a total of 911,554 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.
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
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.
Condition: There were 5 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
Effect: For those certifications/re-certifications there was a chance that information was not properly documented
and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received
assistance for which they were not eligible.
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
Condition: There were 6 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.
Recommendation: 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.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 from a total of 911,554 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.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.