OPA: 5 audit recommendations to MRSO unresolved, 2 are resolved

The Office of the Public Auditor has found that its 2021 audit recommendation for the Medical Referral Services Office to negotiate an agreement with travel agencies to ensure cheaper airfare for patients and escorts remains unresolved.

OPA said that, based on that Dec. 20, 2022, information provided by the Commonwealth Healthcare Corp., OPA will follow up on CHCC’s progress toward addressing the recommendation in the next reporting period.

OPA noted that on Nov. 11, 2021 they requested CHCC to provide a status update on the actions they have taken to address the recommendation, but CHCC did not respond.

OPA said that on Dec. 20, 2022, CHCC provided a copy of CHCC’s memorandum pertaining to staff medical escorts for medical referral patients. OPA, however, pointed out that CHCC’s memorandum does not address the recommendation.

OPA has tracked 36 unresolved audit and inspection recommendations to various government agencies as of Dec. 31, 2021, which includes seven new recommendations for CHCC.

OPA audit manager Dora Deleon Guerrero said that OPA tracked 36 audit and inspection recommendations from June 30, 2021 to Dec. 31, 2021, and that most of the unresolved recommendations are with the Department of Finance at 20.

With respect to CHCC, OPA said other unresolved recommendations to the Medical Referral Services Office are to develop a plan to meet with all stakeholders and establish proper internal controls to ensure affordable, effective, and equitable program; and collaborate with stakeholders to review previously executed contracts and/or agreements and renegotiate terms to ensure a cost-effective and equitable program.

Other unresolved recommendations are to implement standard operating procedures to ensure proper reconciliation of all vendor billings and payments; and implement standard operating procedures to ensure fair and equitable assessment of patient and escort eligibility in compliance with the requirements established in MRSO’s laws and internal policies.

Recommendations that OPA determined as resolved are to seek additional assistance from the Office of the Attorney General for further proceedings pertaining to the collection of promissory notes payments, and implement SOP for all three MRSO offices to safeguard check inventory of all used and unused checks.

As to unresolved recommendation to develop a plan to meet with all stakeholders, OPA said that on June 15, 2022, CHCC met with the stakeholders and established proper internal controls by moving the accounting section under the direction of the CHCC chief financial officer and ensuring the adherence to Chapter 75-50 of the Medical Referral regulations and compliance with generally accepted accounting principles.

On Dec. 20, 2022, CHCC provided OPA with a memorandum regarding MRSO organization structure and a copy of the MRSO organizational chart.

OPA said that, based on that Dec. 20, 2022, information provided by CHCC, OPA will follow up on CHCC’s progress toward addressing the recommendation in the next reporting period.

Regarding the recommendation to collaborate with stakeholders, on Dec. 20, 2022 CHCC provided OPA with an agreement and policies for two transportation vendors. CHCC noted that contracts with two hotel vendors are currently routing for review and signature.

OPA said the hotel vendors are currently charging CHCC monthly to avoid disruption of patient care.

OPA said that, based on the Dec. 20, 2022, information provided by CHCC, they will follow up on CHCC’s progress towards addressing the recommendation in the next reporting period.

With respect to recommendation to implement SOP to ensure proper reconciliation, OPA said that on Dec. 12, 2022 they requested CHCC to provide SOP pertaining to the MRSO accounting section that was moved under the direction of the CHCC chief financial officer.

OPA said CHCC, however, on Dec. 20, 2022 provided with a memorandum regarding MRSO organizational structure and a copy of the MRSO organizational chart.

On the recommendation to implement SOP to ensure fair and equitable assessment of patient and escort eligibility, OPA noted that on Dec. 20, 2022, CHCC informed OPA on the status of the “Health System Network Program Patient Family and Other Designated Escort” operating policy.

On resolved recommendation to seek additional assistance from the OAG, OPA noted that on Dec. 28, 2022, the Senate passed House Bill 22-77 and officially became Public Law on Jan. 31, 2023.

OPA said given that Public Law 22-33 authorized the CNMI government to write off promissory notes executed between MRSO and patients or their personal representatives, OPA determines that this recommendation is no longer applicable and is therefore resolved.

Pertaining to the resolved recommendation to implement SOP for all three MRSO offices, on Dec. 20, 2022, CHCC provided OPA a directive dated May 1, 2022 stating that effective the week ending June 3, 2022, CHCC Health System Network will begin utilizing the debt card program that was acquired by the Department of Finance for payment of subsistence allowance.

OPA said that, given that CHCC no longer issues checks for subsistence allowance, they determine that this recommendation is no longer applicable and is therefore resolved.