Finding Text
US Department of Health and Human Service
Passed through the NC Dept of Health and Human Services
Finding: 2022-008
NONCOMPLIANCE / SIGNIFICANT DEFICIENCY
Eligibility
Criteria:
Condition:
Context:
Effect:
Cause:
Section III - Federal Award Findings and Questioned Costs (continued)
AL # 93.778
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 that clearly indicates
what actions were performed and the results of those actions.
Inaccurate Information Entry
In accordance with 42 CFR 435, documentation must be obtained as needed to determine if
a recipient meets specific income 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.
There were 9 errors discovered during our procedures that inaccurate information was
entered when determining eligibility. One applicant received assistance although the family
income were above the State provided income Standard.
$569.12. This amount was determined by totaling all the aid received by the applicant who
was not eligible.
Questioned Costs:
The County agrees with the finding. See corrective action plan.
Identification of a repeat
finding:
This is a repeat finding from the immediate previous audit, 2021-009.
Views of Responsible
Officials and Planned
Corrective Actions:
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
Program Names: Medical Assistance
We examined 60 cases from of a total of 402,727 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit
as it relates to Medicaid administrative cost compliance audit.
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, a participant could have been approved to receive benefits for which they were
not eligible.