Finding 969846 (2023-010)

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 2023-010 Inadequate Request for Information SIGNIFICANT DEFICIENCY Eligibility Section III. Federal Award Findings (continued) Criteria: 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. Condition: There were 7 errors discovered during our procedures that inadequate information was requested at applications and/or redeterminations. Questioned Costs: There was no known affect to eligibility and there were no known questioned costs. Context: We examined 60 cases from of a total of 236,377 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. Effect: 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. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective Action Plan. Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect application of rules for purposes of determining eligibility. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-008. Recommendation: 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. Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-007. 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. Views of responsible officials and planned corrective actions: The County agrees with the finding. See Corrective Action Plan.