Finding 485706 (2022-001)

Program: HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Federal Agency Name: U.S. Department of Health and Human Services Federal Award Number: N/A Federal Award Year: 2021 – 2022 Federal Assistance Listing Number: 93.461 Compliance Requirement: Activities Allowed or Unallowed Criteria The terms and conditions for Participation in the HRSA COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program allows for reimbursement of payment for COVID-19 testing and testing related items, COVID-19 treatment or COVID-19 vaccine administration fees as determined by the program for individuals who do not have any health care coverage at the time the services were rendered. Funds provided will not be used to reimburse expenses that have been reimbursed from other sources. Conditions Found During our testing of the internal controls and compliance over the Activities Allowed and Unallowed process, we noted controls that were designed to ensure that HRSA claims reimbursements were submitted for eligible individuals for certain locations associated with a certain urgent care subsidiary were ineffective in certain circumstances. To test the compliance of this process, we tested a total of 45 HRSA claim reimbursement transactions to ensure individuals were uninsured at the time of the service and received an allowable COVID-19 service as per the terms and conditions. We noted for a certain urgent care subsidiary, that 7 of the 8 tested claims were not eligible for reimbursement as the individual either did have insurance at the time of service or the claim was already reimbursed from other sources. The HRSA claims reimbursements associated with this certain urgent care subsidiary was $40,150 for the year ending June 30, 2022. The 7 tested claims that were not eligible for reimbursement were $100 each, which total to the $700 of questioned costs. The sample was not intended to be, and was not, a statistically valid sample. This audit finding is reported as the likely questioned costs could possibly exceed the reporting threshold of $25,000. Management is evaluating the total amount to be remitted back to HRSA. Cause The above finding was caused by a lack of adequate training and monitoring at this certain urgent care subsidiary of the personnel tasked with submitting lab requisitions for COVID-19 tests performed.Effect The schedule of expenditures of federal awards is inappropriately stated as of June 30, 2022 because ineligible costs were charged to the program. Questioned Costs $700 Recommendation We recommend that QHS implement procedures and policies to ensure that the individuals included in HRSA claim reimbursements are uninsured at time of service and that the claim has not been reimbursed from other sources. Views of Responsible Officials QHS agrees with the finding and accepts the recommendation.