Finding Text
Assistance Listing Number, Federal Agency, and Program Name - 93.461, Department of Health and Human Services, COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund
Federal Award Identification Number and Year - N/A
Pass through Entity - N/A
Finding Type - Significant deficiency
Repeat Finding - Yes
Prior year finding number: 2021-001
Criteria - The COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund grant is to be used for "reimbursement of payment for COVID-19 testing and testing related items for individuals who do not have coverage through an individual or employer sponsored plan," per the 2022 Compliance Supplement.
Condition - WakeMed charged costs associated with ineligible individuals to the grant.
Questioned Costs - None
Identification of How Questioned Costs Were Computed - N/A
Context - During testing of 60 patients, we identified 1 patient who should not have been submitted to HRSA for reimbursement, as they were covered by insurance and, therefore, ineligible. The ineligible cost was removed from the SEFA and is in the process of being refunded to HRSA.
Cause and Effect - While WakeMed had a process in place to review individuals for eligibility prior to claims being submitted, there was no process to subsequently evaluate changes in insurance status that may result in the patient being ineligible for the program.
Recommendation - WakeMed should have a process in place to review and identify claims in which insurance status may have changed, in which refunds need to be issued to HRSA.
Views of Responsible Officials and Corrective Action Plan - Management agrees with the finding as reported. WakeMed identified all HRSA patients with other documented insurance within the system. Each claim was reviewed to identify patients with active insurance coverage. Patients identified with active insurance coverage were considered ineligible for grant purposes, and the HRSA payments are in the process of being refunded. These costs were removed from the SEFA. In addition, WakeMed has written off all outstanding HRSA claims.