Finding 382709 (2023-001)

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 2023 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 patients who had insurance coverage. Questioned Costs: Known questioned costs are $31,408 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 2023, from a total population of 8,424 claims billed to the federal program. The sample was not intended to be, and was not, a statistically valid sample. Three patients were initially considered uninsured, and the claims were billed to the federal program. It was later determined that the patients had insurance coverage; and were not eligible for this program. Effect or Potential Effect: Program funds were drawn to cover claims for patients who had insurance. Cause: Internal controls were not adequately designed and implemented to ensure compliance with the program requirements. Identification as a Repeat Finding: Is a repeat finding. See 2022-002 and 2021-002. Recommendation: We recommend implementing controls to ensure review of patient insurance coverage and that the refund process is completed timely.