Finding Text
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)
CFDA# 93.778
Finding 2022-008 Inadequate Request for Information
SIGNIFICANT DEFICIENCY
Eligibility
NORTHAMPTON COUNTY, NORTH CAROLINA
Schedule of Findings and Questioned Costs
For the Year Ended June 30, 2022
Section III. Federal Award Findings (continued)
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. Electronic
matches are required at applications and redeterminations.
Condition: There were 17 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
Context: We examined 60 cases from of a total of 255,485 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.
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.
Views of responsible officials and planned corrective actions: The County agrees with the finding. See
Corrective Action Plan.
136