The Office of the Comptroller of Puerto Rico issued a qualified opinion of the operations of the Office of Information Systems of the Office of the Patient's Advocate of the Commonwealth of Puerto Rico (OPP). A qualified opinion is issued when the noncompliances, individually or together, are significant but not pervasive.
The Report reveals that the Office of the Patient's Advocate contracted, for $9,300 in 2019, the professional services to develop a program that collects and interprets the information provided by the health insurance companies. However, as of March 10, 2022, the OPP had not used the program.
This situation is due to the fact that no needs study was conducted, no proposals were requested for the development of the program, and no supervision was carried out of the agreed-upon work. The computing officer indicated that, from the beginning, the program presented errors and that he was never consulted about its compatibility with the existing equipment and programs.
In fact, the OPP had to incur additional expenses by granting another contract for $15,000 in 2021, to, among other things, develop the Quarterly Report Module required by Act 47 of 2017, the Patient's Advocate Enabling Act. This module would give access to the insurance carriers to enter the information on the denied services.
The four-finding audit notes that the OPP has not complied with the publication of the insurance companies' quarterly reports on its website. The health companies are required by law to record the adverse determinations of a service and their justifications.
This situation does not allow the patient to have sufficient data when selecting an insurer, and the purpose of the law that insurers use only valid, non-arbitrary criteria to deny a service is not achieved.
As of October 26, 2021, the OPP did not have a risk-analysis report of the computerized systems or an incident-management plan. This situation would affect the restoration of the systems in the event of unexpected situations.
In addition, as of August 22, 2022, the OPP had also not made backups of the information stored in the Patient's Advocate Integrated Electronic System. This situation can cause the permanent loss of the recorded information. The report covers the period from May 8, 2019 to April 26, 2022.
See Audit Report TI-23-03.
To see other published reports, visit our Audit Reports section.
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