Finding Text
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 2 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 not a repeat finding.
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 respectfully disagrees with the characterization of the finding as a material weakness in internal control over compliance and material noncompliance. A sliding fee program was adopted that provides discounts to eligible patients and Indian tribes. A guideline was implemented to serve those who are federally eligible with documentation to support the assertions for eligibility and approval of the discount consideration. Staff are well-trained and are aware of the federal regulation that the Health Board will adhere to it and it is included in the policy. Considering a 3% error of the sample (2 out of 60) outcome of the audit, the Health Board feels it is immaterial. Management believes that there is adequate internal control that will safe guard the assets of the organization and comply with federal and local government regulations. While the expertise of the audit team is valued and insights are appreciated, the Health Board believes that labeling this finding as a material weakness does not accurately reflect the overall strength and effectiveness of the internal control over compliance.