Finding Text
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2023-004 IV-D Cooperation with Child Support
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Section II - Financial Statement Findings (continued)
The County agrees with this finding.
In accordance with North Carolina General Statutes SS 143C, budget revisions must be requested and
approved prior to any commitment and/or expenditure that would exceed the amount budgeted. Entities should
not overspend the authorized budget.
The County overspent in Information Technology by $199,505, Court Facilities by $5,908, General and
Administrative by $210,485, Jail by $1,491, and Emergency Services by $29,403. This was an oversight that
resulted from not budgeting for GASB 96 entries. Efforts will be made to ensure that the budget is
appropriately amended in the future.
The Board spent funds that were not available for those respective departments.
The County did not properly amend the budget as needed to account for the GASB 96 entries that were
necessary in the current year.
The budget should be reviewed and appropriate amendments made during the year.
Section III - Federal Award Findings and Questioned Costs
There was no known affect to eligibility and there were no known questioned costs.
There were 7 errors discovered during our procedures that referrals between DSS and Child Support Agencies
were not properly made.
In accordance with the Medicaid Manual MA-3365, all Medicaid cases should be evaluated and referred to the
Child Support Enforcement Agency (IV-D). The Child Support Enforcement Agency (IV-D) can assist the
family in obtaining financial and/or medical support or medical support payments from the child’s noncustodial
parent. Cooperation requirement with Department of Social Services (DSS) and Child Support
Agencies must be met or good cause for not cooperating must be established when determine Medicaid
eligibility.
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.
We examined 60 cases from of a total of 754,993 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.
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2023-005 Inaccurate Information Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Identification of a repeat
finding:
Cause:
Recommendation:
Views of responsible
officials and planned
corrective actions:
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 754,993 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.
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.
This is a repeat finding from the immediate previous audit, 2022-006.
Section III - Federal Award Findings and Questioned Costs (continued)
The County agrees with the finding. See Corrective Action Plan in the following section.
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 eligibilitydeterminations. 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 5 errors discovered during our procedures that inaccurate information was entered when
determining eligibility.
Human error in reading the Automated Collection and Tracking System (ACTS) report and/or ineffective case
review process.
Files should be reviewed internally to ensure proper information is in place and necessary procedures are taken
when determining eligibility. 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. See Corrective Action Plan in the following section.