Finding 374633 (2023-001)

Finding 2023-001 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 Award No. 58G950028 Year 2023 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 adjusted to the IHS compact. Cause The Association is in the process of ensuring all the eligibility information is retained in the patient records. 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 5 of those patients, documentation proving eligibility was not on file. Identification as a repeat finding Was reported as finding 2022-003. 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 adjusting 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.