Finding 588252 (2023-003)

US Department of Health and Human Services Passed through the NC Department of Health and Human Services Program Name: Medicaid Assistance Program (Medicaid; Title XIX) AL # 93.778 Finding: 2023-003 Inadequate Request for Information SIGNIFICANT DEFICENCY Eligibility Criteria: Condition: Questioned Cost: Context: Effect: Identification of a repeat finding: Cause: Recommendation: Views of responsible officials and planned corrective actions: Program Name: Medical Assistance Program (Medicaid; Title XIX) AL # 93.778 None reported. Section V - Passenger Facility Charge Program Findings and Questioned Costs For those certifications/re-certifications there was a chance that information was not properly documented and reconciled to NC FAST and applicants could have been approved for benefits for which they were not eligible. Error in reading the ACTS report and/or ineffective case review process. 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. The County agrees with the finding. See Corrective Action Plan in the following section. This is a repeat finding from the immediate previous audit, 2022-004. We examined 60 cases from of a total of 896,867 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. There were no known affects to eligibility and there were no known questioned costs. Section III - Federal Award Findings and Questioned Costs (Continued) SIGNIFICANT DEFICENCY: Finding 2023-001, 2023-002, and 2023-003 also apply to State requirements and State Awards. The County agrees with the finding. See Corrective Action Plan in the following section. Section IV - State Award Findings and Questioned Costs 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. Electronic matches are required at applications and redeterminations. There were 3 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations.