THE Bureau of Medical Referral Services or MRSO lacks internal controls over its contracts and agreements; has no legal basis for executing promissory notes; and does not comply with applicable laws and internal policies, the Office of the Public Auditor said in its audit of the program.

The OPA said it also found that the organizational structure of MRSO was unclear; and patients and / or attendants are sent on medical recommendation at unrestricted economy class air fares at high cost.

The OPA said these results “reveal that MRSO does not have effective internal controls in place to ensure (1) good cash management and (2) compliance with applicable laws and internal policies, posing a problem. permanent potential risk of fraud, waste and abuse “.

According to internal policy, the OPA said: “The MRSO is responsible for facilitating the referral of patients to recognized referral health facilities outside of the CNMI for prolonged medical care. This includes accommodation, ground transportation and subsistence allowance…. Additionally, the MRSO exists to help with the financial obligations of people who meet certain eligibility criteria.

The OPA said that the operation of MRSO “has resulted in a significant discrepancy between the appropriate amount and the expenditure declared by MRSO”. This “raised significant concerns regarding MRSO’s budget control and cash management” and “suggests that the program has either been (1) underfunded through the Budget Appropriations Act by the legislature and / or (2) exceeded its allocation, ”said the OPA.

In previous statements to the Legislature, public health and medical referral program officials said the program was still underfunded.

In fiscal 2019, for example, the program was budgeted at $ 2.9 million, but its actual spending was $ 17 million.

The OPA said MRSO spent $ 27 million more than its budget in fiscal years 2018-19.

According to the OPA, the medical referral program was initially under the auspices of the Department of Public Health, and later, of the Commonwealth Healthcare Corp.

He was transferred to the governor’s office by an executive order signed by the late Governor Eloy S. Inos on May 2, 2013, but in June 2021, the attorney general’s office declared Governor Inos to have no legal authority. remove the MRSO from the CHCC and place it under the governor’s desk. “As a result,” the OPA said, “the regulations of the MRSO, which were promulgated under the governor’s office, are without legal force and effect.”

The OPA made the following recommendations to MRSO:

1) Develop a plan to meet with all stakeholders and establish appropriate internal controls to ensure an affordable, efficient and fair program.

2) Work with relevant stakeholders to review previously executed contracts and / or agreements and renegotiate terms to ensure a cost effective and fair program.

3) Implement standard operating procedures to ensure proper reconciliation of all supplier invoices and payments.

4) Seek further assistance from the Office of the AG for other procedures relating to the collection of promissory note payments.

5) Implement standard operating procedures to ensure a fair and equitable assessment of patient and attendant eligibility in accordance with applicable requirements established in laws and internal MRSO policies.

6) Negotiate and establish an agreement with the applicable travel agencies to guarantee profitable air fares for patients and accompanying persons.

7) Implement standard operating procedures for the three medical referral offices (Saipan, Guam and Hawaii) to protect the inventory of all used and unused checks.

The MRSO said it agreed with the OPA’s recommendations, but noted that since the inception of the medical referral program, there was no law to establish it.

MRSO said it should be legally established as an independent executive body and appropriately funded.

The CHCC, for its part, noted that the OPA itself has stated that “in the absence … of enabling legislation, legislated regulations or adopted standard operating procedures, the MRSO is left without proper direction. to ensure efficient operations ”.

CHCC added: “Unfortunately, although the Attorney General believes that CHCC should administer … medical referral, CHCC is unable to respond to this conclusion … because the repeal of subsection (v) of 3 CMC § 2824 by PL 19-78 took over the authority to pass regulations when off-island care is necessary and appropriate. A law must be adopted to remedy this finding of organizational structure. “

According to the OPA, however, “CHCC should seek the advice and guidance of the [Office of the] AG to determine the legal entity to promulgate the rules and regulations for the MRSO.

To read the OPA report, go to https://www.opacnmi.com/oockuvoa/2021/09/Audit-of-the-CNMI-Medical-Referral-Services-Office-1.pdf