Finding 382704 (2021-002)

Department of Health and Human Services HRSA COVID-19 Claims HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Assistance Listing 93.461 Program Year 2021 Criteria: Activities Allowed or Unallowed and Eligibility – Per 2 CFR Part 200, services must be for individuals, who at the time the eligible services were provided, were uninsured as described in the terms and conditions. Condition: The Authority received program funds for a patient who had insurance coverage and two patients where the services performed were not eligible services as described in the terms and conditions. Questioned Costs: Known questioned costs are $487 calculated as the amount of federal funds received for individuals who had insurance at the time of service. Context: We tested 40 claims billed to the federal program during 2021, from a total population of 41,985 claims billed to the federal program. Errors were noted for three claims out of the 40 sampled. The sample was not intended to be, and was not, a statistically valid sample. One patient was initially considered uninsured, and the claim was billed to the federal program. It was later determined that the patient had insurance coverage and was not eligible for this program. In addition, two other patients were uninsured; however, the primary diagnosis was not COVID-19, as required by the terms and conditions. Accordingly, the services were not eligible for reimbursement. Effect or Potential Effect: Program funds were drawn to cover a claim for a patient who had insurance or whose services were not eligible for reimbursement. Cause: Internal controls were not adequately designed and implemented to ensure compliance with the program requirements. Identification as a Repeat Finding: Not a repeat finding. Recommendation: We recommend implementing controls to ensure review of patient insurance coverage and that the refund process is completed timely.