That’s because DPH does not have direct access to the health insurance records for the people who were tested at the nursing homes, DPH officials said. The testing companies collected and maintained that information themselves.
The state auditors said that opened up the possibility that the six testing companies got to keep more money than they were entitled to under the contracts.
“The lack of insurance recovery remittances likely resulted in overpayments to the contractors,” the auditors wrote in their report.
“We are not accusing anybody of wrongdoing,” John Geregosian, one of the two state auditors, said. “All we know is that some of the contractors didn’t give any money back to the state from insurance payments they could have collected as the contract required them to do, and that four of them did.”
The CT Mirror emailed and called all six of those companies seeking an explanation about the audit’s findings. Officials with four of those testing providers responded.
Yale New Haven Health, which is the largest health care system in the state, and SEMA4, a private lab company, said they did not return any money because they never charged the state for tests that were covered by a health insurance plan. They kept the two billing processes separate, they said.
“We can state very directly, that if we billed insurance, we did not also bill the state,” said Vincent Petrini, a senior vice president with Yale New Haven Health. “As a result, we never received both an insurance payment and a state payment for the same test. We are entirely comfortable working with the state to review any of these transactions during the course of the pandemic.”
“We adhered to our contractual obligations to the state for long-term care facilities, including all billing and reporting requirements,” a spokesman for SEMA4 said. “We did not bill the state for tests that were paid by insurance.”
Officials with the Eastern Connecticut Health Network and Waterbury HEALTH, which were previously operated by Prospect Medical Holdings, said they were confident that their two companies were not overcompensated for the work they performed.
“ECHN and Waterbury HEALTH provided detailed patient data to the State of Connecticut’s Department of Health in order to be funded for the COVID testing services provided,” said Nina Kruse, a chief communications officer for the two health care companies. “We have reviewed the number of tests performed and the amounts received and can confirm we did not receive any overpayment for this testing.”
Officials at DPH also pushed back against the audit findings. They explained that the agency’s lack of oversight with the insurance payments was due to the fast-paced nature of the pandemic and the corresponding crisis that played out at 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 while the residents and staff at the nursing homes were at severe risk of contracting the virus.
“The urgency to perform these testing services was necessitated by the pandemic and the imminent crisis at these facilities,” DPH officials wrote in response to the audit.
“The process of review, vetting and validating the numerous weekly payment requests from the care partners prior to making payments was determined to be a burden to the exceptionally time sensitive and critical nature of the COVID-19 testing services at these nursing home facilities,” the agency added.
DPH officials told the CT Mirror that the agency is in the process of reviewing all of the work performed by the 10 testing providers and determining whether any of those companies owed the state money.
The contracts that the testing companies signed allow the state health agency to perform follow-up audits to ensure the businesses didn’t overbill the state for testing or pocket any additional profits.
“The Department of Public Health is thoroughly reviewing all providers’ submissions for compliance with their contracts,” said Chris Boyle, a spokesman for DPH. “This process was underway, even prior to the release of this audit. DPH is working with the auditors and will continue to update them on our progress.”
If any companies were overpaid for the lab testing or failed to pass insurance payments on to the state, Boyle said, DPH would seek to collect on those debts.
“The results of that thorough review will determine if funds are to be returned to DPH,” he said. “If needed, DPH will take action to provide for the prompt return of those monies.”
The testing providers may need to wait a little longer for those results.
State officials told the CT Mirror that the review of the testing contractors may not be finished until late November.