Finding 1175958 (2025-001)

Finding 2025-001 Eligibility – Noncompliance and Significant Deficiency in Internal Control Over Compliance Agency U.S. Department of Health and Human Services Program Tribal Self-Governance Program: IHS Compacts/Funding Agreements Assistance Listing: No. 93.210 (Direct and pass-through Alaskan Native Tribal Health Consortium) Award No. 58G950028, 24-U-428002, 25-U-4599796 Year 2025, 2024, 2020, 2018, and 2019 Criteria or Specific Requirement In accordance with the IHS funding agreement requirements, as well as Uniform Guidance compliance requirements, the Association is required to maintain documentation of eligibility for the patients receiving medical assistance under the IHS program. Condition The Association was unable to provide proper documentation regarding eligibility of some of the patients for which their accounts were charged to the IHS compact. Cause The Association has multiple remote locations where there are challenges due to staffing and the Association has difficulty in obtaining eligibility information from older beneficiaries. Effect or Potential Effect Individuals may receive services funded by the IHS program who are ineligible to receive these benefits. Questioned Costs Unknown Context We tested 40 patients who were designated as IHS beneficiaries. For five of those patients, documentation proving eligibility was not on file. Identification as a Repeat Finding Was reported as finding 2024-001. Recommendation For all patients receiving services, verification of eligibility should be documented and kept on file electronically. If eligibility documentation is not provided, the hospital needs to attempt to collect on the outstanding balance from the individual or insurance companies, rather than charging as an IHS beneficiary. Views of Responsible Official and Planned Corrective Action Management agrees with finding. Monthly audits of the elements of registration, including documentation of beneficiary status will be conducted to ensure continual compliance.