Health department disputes qualified audit

An apparent disagreement over the department of health’s financial records for the Covid-19 vaccination programme has led it to receive a qualified audit for the 2021/2022 fiscal year, the first time in more than a decade that it has failed to get a clean bill of health from the auditorgeneral.

A qualified audit signals the auditor-general is not satisfied that an entity has properly accounted for the money allocated to it. The last time the department received a qualified audit was in 2010/2011.

The department procured Covid-19 vaccines on behalf of the entire population and established a programme that allowed people to obtain free shots at either public or private sector sites, regardless of their medical scheme status.

A complex reconciliation process has ensued, with the state claiming payments from medical schemes for members who received jabs at public sector sites, while private sector providers have sought reim

bursement from the department and medical schemes.

Auditor-general Tsakani Maluleke said she was unable to obtain sufficient audit evidence for R2.079bn in accrued revenue the department had attributed to Covid-19 vaccines for 2021/2022.

“The systems of internal controls implemented by the department were not always adequate for the recording of some transactions and events relating to the recoupment process of the Covid-19 vaccine programme.

“I could not confirm accrued departmental revenue by alternative means,” she said in the department of health’s 2021/ 2022 annual report, which has been tabled in parliament.

The department is “extremely disappointed” with the auditor-general’s conclusion, said deputy director-general for National Health Insurance Nicholas Crisp, who heads the vaccination programme.

The financial reconciliation of the programme was extremely complicated, partly because the payment for each shot was determined by an individual’s medical scheme status on the date they received their jab.

He said the auditor-general failed to appreciate that the medical scheme population was in constant flux, and it was thus inappropriate to reconcile records drawn on different dates. Individuals switched schemes, resigned, ceased to be dependants or took up membership for the first time.

“The AG has not understood how the reimbursement of vaccinations works. We have tried to explain, but even the actuaries who manage the private interface have not been able to convince them. We provided everything asked for,” Crisp said.

The reconciliation of payments will take several more months to finalise, he said, expressing confidence that the numbers will tally at the end of the process.

He told parliament last month that private providers have so far submitted R2bn in claims for shots administered to people who did not belong to medical schemes, while medical schemes have paid the government R1.3bn for members who had received their shots at public health facilities.

“In the beginning we were more worried about vaccinating people than who would pay,” Crisp said.

Discovery Health’s chief commercial officer, Ronald Whelan, said the reconciliation of payments due to the government for medical scheme members vaccinated at public sector sites is relatively straightforward, but the reimbursement of private sector providers for state patients is more complicated. Claims have to be validated against the electronic vaccination data system, the quantity of vaccines delivered to sites, and the medical scheme status of vaccinees. “Each of these elements is complex, but we are collectively working to get these reconciliations as accurate as possible. There is good collaboration … and all the checks and balances are in place,” he said.

Auditor-general spokesperson Africa Boso said Maluleke will answer media queries only after she had tabled her general report for national and provincial government departments in parliament on November 23.