Methodist Health System

Finding: 2021-001 Federal Agency: U.S. Department of Health and Human Services Federal Program: COVID-19 HRSA Uninsured Program CFDA: 93.461 Award Year: 2021 Type of Finding: Non-compliance and Significant Deficiency Compliance Requirement: Eligibility/Activities Unallowed Criteria: Services must be for individuals, who at the time the services were provided, were uninsured as described in the terms and conditions. In order to be reimbursed through the uninsured fund, the individual must be uninsured at the time the COVID related testing or diagnosis was provided. Funds provided will not be used to reimburse expenses that have been reimbursed from other sources or that sources are obligated to reimburse. Condition: Forty individuals were selected for Eligibility and Activities Unallowed testing. During our testing of these compliance requirements, we noted no exceptions. However, in response to the prior year 2020-001 finding, the Entity chose to review all patients for which reimbursement was made. The Entity?s review noted four patients for which a refund was required totaling $146,350. Questioned Costs: $146,350 Context: Funds were reimbursed for ineligible costs. Cause: The above finding resulted in a failure to evaluate and review the following: - All accounts with an HRSA Uninsured payment where other insurance was added to the account - if the other insurance subsequently paid - if the account had a HRSA Uninsured payment, and - if HRSA Uninsured and other insurance, paid a refund was due to HRSA Uninsured Program. Effect: The Entity did not timely refund the Department of Health and Human Services for payments received on patients that were determined ineligible subsequent to payment receipt The ineligibility was a result of patients qualifying for other insurance subsequent to the Entity?s submission for payment from the program. Repeat Finding: Yes, 2020-001 Recommendations: We recommend that the Entity implement enhanced monitoring controls to ensure that refunds are submitted to the program timely. Views of responsible officials: Upon identification during this audit of the refunds due to the Department of Health and Human Services, management reviewed the patient accounts of all patients paid under the HRSA COVID-19 Uninsured Program for any other refunds due to the program. As of June 8, 2022, payment was submitted to the appropriate HRSA refund address for all refunds identified. On June 8, 2022, education was provided to the MHS Vice President of Central Billing and Collections, the Assistant Vice President of Central Billing, and the Director of Billing to reinforce the daily procedures required to comply with MHS? billing and collection process guidelines, which include the daily monitoring of credit balance workqueues. Daily monitoring of these credit balance workqueues will result in timely submission of refunds in the future.

Finding: 2020-001 Federal Agency: U.S. Department of Health and Human Services Federal Program: COVID-19 HRSA Uninsured Program CFDA: 93.461 Award Year: 2020 Type of Finding: Non-compliance and Significant Deficiency Compliance Requirement: Eligibility/Activities Unallowed Criteria: Services must be for individuals, who at the time the services were provided, were uninsured as described in the terms and conditions. In order to be reimbursed through the uninsured fund, the individual must be uninsured at the time the COVID related testing or diagnosis was provided. Funds provided will not be used to reimburse expenses that have been reimbursed from other sources or that sources are obligated to reimburse. Condition: Forty individuals were selected for Eligibility and Activities Unallowed testing. During our testing of these compliance requirements, the following exception was noted: - One patient was noted to not have insurance but subsequent to receiving reimbursement through the HRSA Program in the amount of $100, it was discovered that the patient did in fact have insurance and a claim was submitted and paid by the insurance provider. The Entity did not refund the HRSA Uninsured Program for the payment they received from the insurance provider. In response to the above finding, the Entity chose to review all patients for which reimbursement was made. The Entity?s review noted three additional patients for which a refund was required totaling $305. Questioned Costs: $305 Context: Funds were reimbursed for ineligible costs. Cause: The above finding resulted in a failure to evaluate and review the following: - All accounts with an HRSA Uninsured payment where other insurance was added to the account - if the other insurance subsequently paid - if the account had a HRSA Uninsured payment, and - if HRSA Uninsured and other insurance, paid a refund was due to HRSA Uninsured Program. Effect: The Entity did not timely refund the Department of Health and Human Services for payments received on patients that were determined ineligible subsequent to payment receipt The ineligibility was a result of patients qualifying for other insurance subsequent to the Entity?s submission for payment from the program. Repeat Finding: No Recommendations: We recommend that the Entity implement enhanced monitoring controls to ensure that refunds are submitted to the program timely. Views of responsible officials: Upon identification during this audit of the refunds due to the Department of Health and Human Services, management reviewed the patient accounts of all patients paid under the HRSA COVID-19 Uninsured Program for any other refunds due to the program. As of June 8, 2022,payment was submitted to the appropriate HRSA refund address for all refunds identified. On June 8, 2022, education was provided to the MHS Vice President of Central Bill and Collections, the Assistant Vice President of Central Billing, and the Director of Billing to reinforce the daily procedures required to comply with MHS? billing and collection process guidelines, which include the daily monitoring of credit balance workqueues. Daily monitoring of these credit balance workqueues will result in timely submission of refunds in the future.