THE Office of Public Accountability has released its audit of Guam Memorial Hospital's billing and collections, revealing what Sen. Dennis Rodriguez has believed all along – not all insurance carriers are prompt with their payments to the hospital.

The report, which is an audit of three years' worth of billings and collections, revealed that the four major insurance carriers – TakeCare Insurance, Calvo's SelectCare, NetCare and Staywell – only paid 68 percent of what they owed from Fiscal Years 2009 to 2011.

The audit identifies the insurance agencies as Payor A, Payor B, Payor C and Payor D, but does not specify them by name.

In 2009, Payor A paid 57 percent of what it owed to GMH, or $2.1 million out of $3.8 million. In 2010, Payor A then paid 80 percent of what it owed, or $3.4 million of $4.2 million. Finally, in 2011, Payor A overpaid the hospital, paying 101 percent, or $3.38 million of the $3.33 million it owed.

The audit states Payor C had the most billings in the three-year period, averaging about $20 million per year, but paid only 69 percent of what it owed over the three-year period.

Altogether, of the $125 million all four insurance carriers and miscellaneous payors owed from FY2009 to FY2011, $85 million was collected, or 68 percent.

In addition, the audit also included a report on billings and collections from the 3Ms – Medicare, Medicaid and the Medically Indigent Program – for the same three periods.

The audit states that on average, GMH collected 47 cents on the dollar of the amounts that were billed to the payors. Medicaid paid on average 54 percent; Medicare, 43 percent; and MIP, 45 percent.

Rodriguez in March wrote to Public Auditor Doris Flores Brooks requesting an audit of all contractual agreements between GMH and all health insurance agencies on Guam.

He made the request in light of an earlier decision the GMHA Board of Trustees made to terminate the direct payer agreement between GMH and TakeCare Insurance that would have affected about 30,000 TakeCare subscribers. GMH, at the time, faulted TakeCare for excessive denial of insurance coverage that other carriers would typically cover.

The decision became a cause of concern for Rodriguez and others within the community. TakeCare and GMH, meanwhile, engaged in a public dispute over billings and collections and disagreed over the amounts owed and the manner by which billings were compiled and reconciled.

Several closed-door meetings later, the GMH board voted to rescind its decision to terminate the contract, to the relief of TakeCare and its members.