Finding Text
Condition: During our review of compliance over eligibility, we identified one ineligible patient related to eligibility testing due to missing documentation to support eligibility determination.
Criteria: Eligibility Control Activities including written policies to provide direction for making and documenting eligibility determinations, procedures to calculate eligibility amounts are consistent with program requirements, and a process for periodic eligibility re-determinations in accordance with program requirements are required to ensure only eligible individuals are receiving assistance using federal funding.
Cause: Internal controls over eligibility compliance requirements were not properly designed and were not placed in operation. Management is responsible for compliance with requirements over Eligibility and for the design, implementation, and maintenance of effective internal controls over compliance with the requirements of laws, statutes, regulations, rules, and provisions of grant agreements applicable to its federal program.
Effect: As a result of this condition, patient medical records include missing information regarding patient’s eligibility to receive medical assistance using federal funding.
Recommendation: We recommend BAIHP implement a checklist detailing what documentation is required and what must be retained when determining a patient is eligible for benefits under the program and should include a secondary review of the patient file by someone other than the preparer.