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Public Summary Report: The State of North Carolina Did Not Ensure That Federal Information System Security Requirements Were Met for Safeguarding Its Medicaid Claims Processing Systems and Data

HHS oversees States' administration of various Federal programs, including Medicaid. State agencies are required to establish appropriate computer system security requirements and conduct biennial reviews of computer system security used in the administration of State plans for Medicaid and other Federal entitlement benefits. This review is one of a number of HHS OIG reviews of States' computer systems used to administer HHS-funded programs. Our objective was to determine whether the North Carolina had implemented adequate information system general controls over the North Carolina Medicaid claims processing systems in accordance with Federal requirements.

The State agency contracts with CSRA, Inc., to operate North Carolina's Medicaid claims processing systems. We assessed the effectiveness of the information system general controls over computer operations at CSRA as those controls related to the North Carolina Medicaid program claims processing for State fiscal year 2016. We reviewed CSRA's information system general controls relating to entity-wide security, access controls, configuration management, network device management, service continuity, mainframe operations, and application change control.

North Carolina had not ensured that CSRA implemented adequate information system general controls over the North Carolina Medicaid claims processing systems in accordance with Federal requirements. The vulnerabilities that we identified increased the risk to the confidentiality, integrity, and availability of North Carolina's Medicaid data.

Although we did not identify evidence that the vulnerabilities had been exploited, exploitation could result in unauthorized access to and disclosure of sensitive information, as well as disruption of critical North Carolina Medicaid operations. As a result, the vulnerabilities are collectively and, in some cases, individually significant and could potentially compromise the confidentiality, integrity, or availability of North Carolina's Medicaid claims processing data and systems. In addition, without proper safeguards, systems are not protected from individuals and groups with malicious intent to obtain access in order to commit fraud or abuse or launch attacks against other computer systems and networks.

We recommend that North Carolina improve the protection of sensitive data on its Medicaid claims processing systems by working with CSRA to address the vulnerabilities identified during our audit to ensure compliance with Federal requirements. North Carolina concurred with our recommendations and described corrective actions that it had taken or planned to take.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

Download the complete report or the Report in Brief.

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201