Finding Text
ALN Number, Federal Agency, and Program Name - 93.461, U.S. 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, 2022 Pass through Entity - N/A Finding Type: Material weakness and material noncompliance with laws and regulations Repeat Finding - No Criteria - The COVID-19 - HRSA Uninsured Program 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 - The Organization charged costs to the grant which were associated with individuals who were subsequently discovered to have insurance. In addition, the Organization did not timely refund private pay patients for payments that were paid by HRSA funding. Questioned Costs - None Identification of How Questioned Costs Were Computed - N/A Context - During testing of 60 patients, we identified three patients who were submitted to the Health Resources and Services Administration (HRSA) for reimbursement, and then a subsequent payment was received from insurance and HRSA or private pay which was not returned timely to the patient or HRSA. Management performed a deeper review of these issues and identified 63 additional patients that fell into one of these two categories. As a result of management's analysis approximately $4,600 was removed from the SEFA and returned to HRSA and approximately $3,900 was refunded directly to patients. Cause and Effect - While the Organization had a process in place to review individuals for eligibility prior to claims being submitted, there was no process in place for when subsequent payments were received from insurance or patients to timely refund the patient or HRSA. Recommendation - The Organization should have a process in place to review and identify subsequent payments on claims for insurance and private pay patient, in which refunds need to be issued to patients or HRSA. Views of Responsible Officials and Corrective Action Plan - Management agrees with the findings as reported. The Organization identified all patients and HRSA refunds.