Finding 31780 (2022-001)

2022-001: Reimbursement of Expenses Applied to Funding Received Compliance Requirement(s): Allowable Costs/Cost Principles Criteria: Program requirements stipulate that providers can identify their expenses attributable to coronavirus, and then must offset these expenses with any amounts received through other sources, such as direct patient billing, commercial insurance, and other funding received. PRF and/or ARP payments may be applied to remaining expenses or costs, after netting the other funds received or obligated to be received, which offsets those expenses. Condition ? During our testing expenses applied to funding received, we noted that no estimate of funds received through patient billing was netted against expenses claimed. Cause ? The cause of this deficiency is due to the lack of internal controls to ensure proper application of the program requirements in relation to netting of expenses utilized for PRF and/or ARP funds received. Effect ? The effect is a potential overstatement of allowable expenses for 2022 and 2021 reported to the Health Resources and Services Administration (HRSA) on the reporting portal. However, the Hospital recognized enough in lost revenues to make up for any potential overstatement of expenses reported. Context ? An exact amount of funding received through insurance reimbursement for expenses used to claim PRF payments could not be determined. However, using the Hospital?s cost-to-charge ratio to estimate potential reimbursement, it is reasonable to determine that the Hospital had enough in lost revenues to cover any potential deficiency due to no netting of expenses. Recommendation ? We recommend that the Hospital implement internal control procedures to ensure proper compliance with program requirements in future reporting periods. Management?s Response ? We will implement internal control procedures to ensure proper reporting of lost revenues, as is required under the reporting guidelines stipulated by HRSA, in future reporting periods.