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: 2023-006 Inaccurate Resource Calculation
SIGNIFICANT DEFICIENCY
ELIGIBILITY
Section III. Federal Award Findings (continued)
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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-004.
Criteria: 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.
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.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-005.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
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.
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.