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)
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.
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 5 errors discovered during our procedures that inadequate information was
requested at applications and/or redeterminations.
There was no known affect to eligibility and there were no known questioned costs.
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: 2023-005 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost: There was no known affect to eligibility and there were no known 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. 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 3 errors discovered during our procedures that inaccurate information was
entered when determining eligibility.
The County agrees with the finding.
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 and 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.
Section III - Federal Award Findings and Questioned Costs (Continued)
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
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.
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.
This is a repeat finding from the immediate previous audit, 2022-006.