Finding Text
Eligibility (Significant Deficiency in Internal Control Over Compliance and an Instance of Non-Compliance)
Criteria – In accordance with the Health Board’s grant award with the Portland Area Indian Health Service, Indian Health Service eligibility regulations require that grantees verify eligibility before providing services, and maintain records documenting such eligibility.
Condition and Context – The Health Board is required to maintain eligibility records for patients who receive services under the Urban Indian Health Services program. These records include Tribal enrollment and insurance coverage, among other things. We randomly selected 60 patients who received services during the audit period and noted the Health Board did not maintain Tribal enrollment documentation for 1 of the 60 patients tested.
Cause – The Health Board staff did not appear to be sufficiently trained to properly identify tribal enrollment documentation and ensure all required documents were obtained prior to providing services.
Effect – Individuals that are not eligible may have received services.
Questioned Costs – Questioned costs associated with this finding could not be determined.
Repeat Finding – This is a repeat finding from the prior year. See prior year finding 2023-002.
Recommendation – We recommend the Health Board update polices and controls to include regular review of patient files. This may include review of the patient file for any outstanding Tribal enrollment and insurance documentation prior to scheduling the patients’ appointment.
Views of responsible officials – Management agrees with the auditors' findings and will implement the corrective action plan to address the issue identified.