Finding Text
Finding 2022-001 Program Name/Assistance Listing Title: HRSA COVID-19 Claims Reimbursement for the Uninsured Program Federal Assistance Listing Number: 93.461 Federal Agency: U.S. Department of Health and Human Services Type of Finding: Significant Deficiency Compliance Requirement: Eligibility Questioned Costs: None Reported Condition: The Organization?s internal controls over compliance related to eligibility were not effective. Criteria: The program requires the Organization to confirm that the patient is uninsured and does not have coverage through an individual, or employer-sponsored plan, a federal healthcare program, or the Federal Employees Health Benefits Program at the time services were rendered, and no other payer will reimburse you for the COVID-19 related care. Context: During the audit, it was determined that 2 of the 40 patients selected for testing had adequate insurance at the time of their visit and therefore did not qualify for reimbursement under the program. Cause: Management oversight. Effect: The Organization?s internal controls around compliance were not effective. Recommendation: We recommend that management have a process in place to review insurance coverage on patients and the visits submitted under this program. View of Responsible Management will review the process that is currently in place to ensure accuracy in the eligibility Officials: calculations under this program.