Finding Text
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Section III - Federal Award Findings and Questioned Costs (Continued)
The County agrees with the finding.
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 noncountable resources and explained within the
documentation.
There were 6 errors discovered during our procedures that referrals between the County's
Department of Social Services and Child Support Agencies were not properly made.
For those certifications/re-certifications there was a chance that information was not
properly documented and reconciled to North Carolina Families Accessing Services
through Technology (NC FAST) and a participant could have been approved for benefits
for which they were not eligible.
Human error in reading the Automated Collection and Tracking System (ACTS) report
and/or ineffective case review process.
This is a repeat finding from the immediate previous audit, 2022-004.
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.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 552,116 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.
Condition:
Questioned Cost:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
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: 2023-004 Inadequate Request for Information
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
There was no known affect to eligibility and there were no known questioned costs.
This is a repeat finding from the immediate previous audit, 2022-005.
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
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.
The County agrees with the finding.
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.
We examined 60 cases from of a total of 552,116 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.
There were 3 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.