Finding 48234 (2022-002)

2022-002 Department of Health and Human Services Federal Financial Assistance Listing #93.461 COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Activities Allowed or Unallowed and Allowable Costs/Cost Principles Significant Deficiency in Internal Control over Compliance Criteria: 2 CFR 200.303 (a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: Our testing identified one instance in which health services provided to a patient were reimbursed under the federal program, and the health services provided did not meet the terms and conditions of the federal program. Cause: Through the coding process, an incorrect Dx Code was included in the system, and therefore, the patient?s health services flowed into Monument Health?s Uninsured Program workflow which resulted in $3,563 of health services being reimbursed under the federal program. Effect: Funds were received under the federal program for health services provided which did not meet the terms and conditions of the federal program. Questioned Costs: None reported. Context: A non-statistical sample of 60 patients were selected for testing, which accounted for $1,659,497 of $4,344,728 of monies received from the federal agency. Repeat Finding from Prior Years: No Recommendation: We recommend management review health services provided to patients to ensure the health services provided are allowable to be reimbursed under the terms and conditions of the federal program. Views of Responsible Officials: Management agrees with the finding.