Finding Text
ALN, Federal Agency, and Program Name - 93.461, Department of Health and Human Services, Health Resources and Services Administration (HRSA), HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Federal Award Identification Number and Year - N/A Finding Type - Significant deficiency and material noncompliance with laws and regulations Repeat Finding - No Criteria - The terms and conditions of the program allow payment to recipients to provide care or treatment related to positive diagnoses of COVID-19 for uninsured individuals. Condition - UCHealth treated a patient with COVID-19 who did not have insurance at the time of service. The patient subsequently applied for and received coverage under Medicaid, with a retroactive coverage effective date prior to the date of service. UCHealth's process failed to identify the patient's subsequent retroactive insurance coverage, and UCHealth received reimbursement under the program. Questioned Costs - $50,808.16 Identification of How Questioned Costs Were Computed - Questioned costs were determined based on the HRSA funds received for the insured patient. Context - During fiscal year 2022, 60 patients were selected for eligibility testing. Of the 60, 1 patient subsequently applied for and received coverage under Medicaid and, therefore, was not eligible under the program. Cause and Effect - An effective control was not in place to ensure that patients who received treatment were not covered by insurance and, therefore, eligible under the program. This resulted in UCHealth receiving HRSA funds for services provided to a patient who had insurance effective at the time of service. Recommendation - UCHealth should establish a formal process to ensure patients treated under the program do not have insurance coverage at the time of service, including a process to identify patients who subsequently receive insurance coverage that is retroactively effective on the date of service prior to seeking reimbursement under the program. Views of Responsible Officials and Corrective Action Plan - UCHealth reviewed the account in question. Emergency Medicaid was found and attached to the account, and a full refund to HRSA COVID-19 was processed on February 1, 2023 in the amount of $50,808.16 on check #431627. Review of the account demonstrated that system actions identified the correct Medicaid coverage and flagged for manual review. User error was made on consecutive days where Medicaid was not properly added to the account. Financial Counseling and Business Services leadership have reinforced coverage attachment protocols with staff on February 24, 2023.