This final report provides the results of our review of the Health Care Financing Administration's (HCFA) Health Maintenance Organization (HMO) Loan and Loan Guarantee Fund for Fiscal Year 1991. The objective of our review was to determine whether the HMO loan fund financial transactions were accurately recorded and reported. We also reviewed internal control policies and procedures for recording and documenting payments, monitoring HMO loans, and writing off delinquent HMO loans. We found that internal controls need improvement to ensure that all HMO loan payments and liabilities are accurately and properly reported and that written procedures are established to document the HCFA deviations from Department of the Treasury reporting. We also found that internal controls need improvement to ensure that the general ledger balance for loans payable is reconciled to the Office of Prepaid Health Care's supporting records.