Finding Text
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.
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: 2023-006 Untimely Review of SSI Termination
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Cost:
Section III - Federal Award Findings and Questioned Costs (Continued)
There was 1 applicant/beneficiary was not reviewed timely and determined to be eligible for
Medicaid when their SSI benefits were terminated.
There was no known affect to eligibility and there were no known questioned costs.
The County agrees with the finding.
This is a repeat finding from the immediate previous audit, 2022-007.
In accordance with the Medicaid Manual MA-3120, the State sends notification to the
County when a participant is no longer eligible under Supplemental Security Income (SSI)
determination, the County is required to initiate the ex parte review within 5 workdays of
the date the termination appears on the SSI Termination Report, and complete the
redetermination within 4 months of the month the case appears on the SSI Termination
Report and notify the recipient about applicant's ongoing eligibility for Medicaid.
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 a participant could have been
approved for benefits for which they were not eligible.
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.