In the rush to test Connecticut nursing home residents and staff for COVID-19, the state’s public health department failed to check test providers, who have been awarded millions of dollars public funding during the pandemic, also received insurance payments that should be returned to the state, according to a recently published audit.
According to state auditors, this oversight may have resulted in test providers being compensated twice — by the state and by insurance companies — for the samples they took. in long-term care facilities.
Uncertainty surrounding testing contracts is largely due to lax record-keeping by the Department of Public Health during the pandemic, as the state relaxed its normal purchasing rules to quickly ramp up its testing capacity, according to the report. ‘audit.
Auditors noted that state health officials failed to conduct checks during the height of the pandemic to determine whether they were overpaying the various testing providers, which they relied on to screen vulnerable patients in homes. of retirement.
The state is only now beginning to review these contracts and the millions of dollars it has paid out to companies.
Between July 2020 and June 2021, the state health department distributed more than $159 million in federal funding to 10 different clinics, hospitals, and private labs to test patients and staff for COVID-19 in 210 nursing homes across the state.
As part of these contracts, the companies agreed to collect information from the people they were testing and to bill the appropriate insurance company if those people were covered by a health insurance policy.
Any insurance money received by test providers was then supposed to be returned to DPH, if the state initially covered the initial cost of those tests.
Public records show that four of the 10 testing companies reimbursed the state last year.
These four companies initially received a combined $138 million from the state to collect COVID-19 samples and analyze them in labs. And they ultimately returned about $22 million to the public health agency after billing various insurance companies.
Griffin Hospital, which did the bulk of nursing home testing during that time, received more than $113 million from the state and returned more than $19 million it collected through insurance claims.
Urgent Care Medical Associates, which received approximately $19.7 million from the state, reimbursed more than $1.1 million in insurance proceeds. Hartford HealthCare, which received $3.5 million, reimbursed nearly $500,000 to the state, and Fair Haven Community Health Clinic, which received $1.3 million from the state for testing , repaid approximately $188,000.
Meanwhile, the other six companies that have been hired to carry out testing in nursing homes have paid no money to the state.
These six companies were Genesys Diagnostics, Prospect ECHN Inc., Prospect Waterbury Inc., Sema4 Genomics, Stamford Hospital, and Yale New Haven Health Services.
According to the audit, state officials were unable to calculate how much these six companies might owe, if anything.
This is because DPH does not have direct access to the health insurance records of people who have been tested in nursing homes, DPH officials said. The test companies collected and stored this information themselves.
State auditors said this opens up the possibility that the six testing companies could keep more money than they were entitled to under the contracts.
“The lack of insurance recovery payments likely resulted in overpayments to contractors,” the auditors wrote in their report.
“We’re not accusing anyone of wrongdoing,” said John Geregosian, one of the state’s two auditors. “All we know is that some of the contractors did not reimburse the state for any insurance payments they might have collected as the contract required them to do, and that four of them did it.”
The CT Mirror emailed and called these six companies for an explanation of the audit findings. Officials from four of those testing providers have responded.
Yale New Haven Health, which is the state’s largest health care system, and SEMA4, a private lab company, said they didn’t return any money because they never billed the state of tests covered by a health insurance plan. They separated the two billing processes, they said.
“We can say very directly that if we were billing insurance, we weren’t also billing the state,” said Vincent Petrini, senior vice president of Yale New Haven Health. “As a result, we have never received both an insurance payment and a payment from the state for the same test. We are completely comfortable working with the state to review either of these transactions during the pandemic.”
“We have met our contractual obligations to the state for long-term care facilities, including all billing and reporting requirements,” a SEMA4 spokesperson said. “We did not charge the state for the tests paid for by insurance.”
Officials from Eastern Connecticut Health Network and Waterbury HEALTH, which were previously operated by Prospect Medical Holdings, said they were confident their two companies were not being overcompensated for the work they were doing.
“The ECHN and Waterbury HEALTH provided detailed patient data to the Connecticut State Department of Health in order to be reimbursed for the COVID testing services provided,” said Nina Kruse, communications manager for the Connecticut State Department of Health. two healthcare companies. “We have reviewed the number of tests performed and the amounts received and can confirm that we have not received any overpayments for these tests.”
DPH officials also pushed back on the findings of the audit. They explained that the agency’s lack of oversight with insurance payments was due to the rapid nature of the pandemic and the corresponding crisis that unfolded in nursing homes across the state.
DPH officials said there was not enough time to fully review the work of each testing company during the public health emergency when nursing home residents and staff were at serious risk. to contract the virus.
“The urgency to perform these testing services has been necessitated by the pandemic and the impending crisis at these facilities,” DPH officials wrote in response to the audit.
“The process of reviewing, verifying and validating numerous weekly payment requests from care partners prior to making payments has been determined to be a burden on the exceptionally time-sensitive and critical nature of COVID-testing services. 19 in these nursing care facilities,” the agency adds.
DPH officials told the CT Mirror that the agency is in the process of reviewing all of the work done by the 10 testing providers and determining whether any of those companies owe the state money.
The contracts the testing companies have signed allow the public health agency to conduct follow-up audits to make sure the companies haven’t overcharged the state for testing or pocketed extra profits.
“The Department of Public Health thoroughly reviews all vendor submissions to ensure they comply with their contracts,” said DPH spokesman Chris Boyle. “This process was ongoing, even before the publication of this audit. DPH is working with auditors and will continue to update them on our progress. »
If companies were overpaid for lab tests or failed to pass insurance payments on to the state, Boyle said, DPH would seek to collect those debts.
“The results of this thorough review will determine whether the funds should be returned to DPH,” he said. “If necessary, DPH will take steps to ensure the prompt return of these funds.”
Test providers may have to wait a bit longer to get these results.
State officials told the CT Mirror that the review of the testing contractors may not be complete until late November.