Finding Text
Department of Health and Human Services HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Assistance Listing 93.461 Program Year 2022 Criteria: Eligibility ? Per 2 CFR Part 200, services must be for individuals, who at the time the services were provided, were uninsured as described in the terms and conditions. Condition: The Corporation received program funds for a patient who had insurance coverage. Questioned Costs: Projected questioned costs are estimated to be $703.74. Context: Two patients were initially considered uninsured, and the claims were billed to the federal program. It was later determined that the patients had insurance coverage through Arkansas Blue Cross; however, the refund process for the program funds was not initiated until this error was noted during the audit. We tested a random sample of 40 claims billed to the federal program during 2022, from a total population of 3,432 claims billed to the federal program. This error was noted for two claims out of the 40 sampled. The sample was not intended to be, and was not, a statistically valid sample. Effect or Potential Effect: Program funds were drawn to cover a claim for a patient who had insurance. Cause: Internal controls were not adequately designed and implemented to ensure compliance with the program?s eligibility requirements. Identification as a Repeat Finding: Yes, 2021-002 Recommendation: We recommend implementing controls to ensure review of patient insurance coverage and that the refund process is completed timely. Views of Responsible Officials and Planned Corrective Actions: Management concurs with the finding and recommendation and will implement controls to ensure all patient insurance coverage is reviewed and that the refund process is completed timely.