Finding 621091 (2022-003)

Criteria: 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: Three eligibility errors were found. One case contained an unverified social security number. One case contained an income error in which the income entered into NC FAST evidence and used for the eligibility determination did not match the verification of income collected at the time. One case was not properly terminated. Questioned Costs: These errors did affect eligibility, however the $955 in claims paid in error did not rise to the level of a questioned cost. Context: Of 470,631 claims, we examined 120 Medicaid cases to re-determine eligibility. These findings were disclosed in a separately issued spreadsheet to the North Carolina Department of Health and Human Services and 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 which affect countable resource and a participant could have been approved for benefits that they were not eligible. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2021-002. 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. Supervisors will complete Monthly Second Party reviews for application approvals/denials and recertifications. These reviews will assist individual workers with noted case errors. Individual counseling will be held with the worker to assure their understanding of the errors.