SSM HEALTH CARE CORPORATION

PART III ? FEDERAL AND STATE AWARD FINDINGS AND QUESTIONED COSTS Reference Number 2020-01 ? Federal Finding ? HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund ? Coverage Discovery control non-compliance Federal Program and ALN # ? HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund ? 93.461 Criteria ? Reimbursement under this program must be for individuals who, at the time the services were provided, were uninsured as described in the terms and conditions of the program. Statement of Condition ? From a sample of 60 patients for which reimbursement was requested under this program, 2 patients were identified to have healthcare coverage as of the date services were rendered. Questioned Costs ? $220.91 known questioned costs and $45,137.19 likely questioned costs. Effect ? SSM Health requested and received reimbursement for patients who did not meet the eligibility criteria. Underlying Cause ? SSM Health?s process for determining eligibility of individuals failed to detect insurance coverage for two accounts in which HRSA reimbursement was requested. Recommendation ? Management should evaluate the current formalized process and system solution to identify further controls to minimize or eliminate recurrence.

Views of Responsible Officials and Planned Corrective Action ? Management acknowledges that although a documented process was established and followed during 2020 and strengthened in 2021 with additional technology, coverage was not identified for two small balance accounts. In response, management will perform an additional automated review of all HRSA funded accounts to ensure qualification for funding.