The Auditor General is painting a poor picture of how the government handles its Medical Care and Dental Health plans in her latest report.
The ultimate conclusion of the report is that the Department of Health and Community Services is “unable to ensure that public health care funds are distributed appropriately to health care providers” through the programs, noting that many of the findings, particularly related to audit and recoveries, are the same as from the last report in 2014.
It describes a system that is “old” and uses “outdated” technology. They say there is a lack of disaster recovery testing and business continuity planning, meaning that “MCP may be unprepared to recover from a catastrophic event, such as a cyber attack.”
They say that MCP has been slow to develop strong control processes, including the prevention of “double payments with Workplace NL,” and controls around manual adult reimbursement are “still not entirely sufficient to prevent potential fraud.”
While the office of the AG has found that the design of the claims audit process is “generally adequate, ” audits often take a long time, which is why delays are hard to understand.
The report notes that in some cases audits were taking years to complete. Within the timeframe of their report 43 per cent of preliminary audits were completed on time, and only 11 per cent of comprehensive audits met the benchmark for completion.
Of those audits, they say that there is “very little success” in recovering money owed to the government. Across their three-year audit period, just over $146,000 was collected – just seven per cent of the $2.2 million owing.
AG Denise Hanrahan has made six recommendations to the province, all of which have been accepted.
Meanwhile, the provincial government notes that they not only have accepted the recommendations in the report, but they have already taken action on several fronts through recommendations in the Health Accord.
This includes work to modernize digital healthcare technology, working with Workplace NL to detect and prevent double billing, and working with the NLMA to review their compliance program and educate physicians about billing practices.
