Finding Text
US Department of Health and Human Services
Passed through the NC Dept. of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL # 93.778
Inadequate Finding: 2023-007 Request for Information
SIGNIFICANT DEFICIENCY
ELIGIBILITY
Recommendation: 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.
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.
Effect: For those certifications/re-certifications there was a chance that information was not properly documented
and reconciled to NC FAST which could affect countable resource. Therefore, applicants could have received
assistance for which they were not eligible.
Context: We examined 60 from a total of 911,554 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: This is a repeat finding from the immediate previous audit, 2022-006.
Identification of a repeat finding: This is a repeat finding from the immediate previous audit, 2022-005.
Questioned Costs: There was no known affect to eligibility and there were no known questioned costs.
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 14 errors discovered during our procedures that inadequate information was requested at
applications and/or redeterminations.
Recommendation: 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.
Views of responsible officials and planned corrective actions: The county agrees with the finding. Please refer
to the corrective action plan for details.
Cause: Ineffective record keeping and ineffective case review process, incomplete documentation, and incorrect
application of rules for purposes of determining eligibility.