Finding 593068 (2022-001)

Finding No. 2022-001: Allowability and Eligibility Federal Program: COVID-19 ? Claims Reimbursement Program for the Uninsured for the COVID-19 Coverage Assistance FundCriteria or Requirement(ALN 93.461) Federal Award Year: July 1, 2021 through June 30, 2022 Federal Award Agency U.S. Department of Health and Human Services Ciiteria or RequirementPer the terms and conditions of the award, the recipient certifies that the patients identified on the claim form were uninsured individuals at the time the services were provided. Per 2 CFR 200.303, the nonfederal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the nonfederal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition Found, Including Perspective For 2 out of 40 patients sampled, the patient had Medicaid or other insurance coverage that was applied subsequently, for the time-period of services provided. Wake Forest University Health Sciences did not refund Health Resources and Services Administration (HRSA) for the amount that was paid on these claims. The amount paid on these claims was $1,504 and the sampled population was $7,551. Possible Cause and Asserted Effect Wake Forest University Health Science?s internal controls failed to prevent the subsequently identified insurance coverage from being added as secondary coverage to HRSA and therefore, the patient claim was submitted to and reimbursed by HRSA and not refunded. Questioned Costs $1,504 Statistical Validity The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding in the Prior Year No. Recommendation We recommend the University enhance the precision of the control around timely identification of coverages added subsequent to the normal control process (but applies to earlier dates of service) which would require refund to HRSA.