Finding Text
2022 002 Assistance Listing Number, Federal Agency, and Program Name 93.461, Department of Health and Human Services, COVID 19 Claims Reimbursement for the Uninsured Program and the COVID 19 Coverage Assistance Fund Federal Award Identification Number and Year N/A Pass through Entity N/A Finding Type Significant deficiency Repeat Finding Yes Prior year finding number: 2021 001 Criteria The COVID 19 Claims Reimbursement for the Uninsured Program and the COVID 19 Coverage Assistance Fund grant is to be used for "reimbursement of payment for COVID 19 testing and testing related items for individuals who do not have coverage through an individual or employer sponsored plan," per the 2022 Compliance Supplement. Condition WakeMed charged costs associated with ineligible individuals to the grant. Questioned Costs None Identification of How Questioned Costs Were Computed N/A Context During testing of 60 patients, we identified one patient who should not have been submitted to HRSA for reimbursement, as they were covered by insurance and, therefore, ineligible. The ineligible cost was removed from the SEFA and is in the process of being refunded to HRSA. Cause and Effect While WakeMed had a process in place to review individuals for eligibility prior to claims being submitted, there was no process to subsequently evaluate changes in insurance status that may result in the patient being ineligible for the program. Recommendation WakeMed should have a process in place to review and identify claims in which insurance status may have changed, in which refunds need to be issued to HRSA.