Audit 16269

2022-001: Significant Deficiency in Internal Control Over Compliance and Compliance Over Application of Sliding Fee Discounts Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Centers Cluster CFDA Number: 93.224 and 93.527 Criteria: The Health Centers Program, 42 U.S.C. ? 245b(k)(3)(G)(i) states that ?the center has prepared a schedule of fees or payments for the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient?s ability to pay.? Condition: During our testing of sliding fee discounts for health center, there were two instances in which the sliding fee was calculated incorrectly. Context: We randomly selected twenty-five sliding fee discounts to test for compliance. Two of the twenty-five sliding fee selections was incorrectly calculated. Questioned Costs: None Cause: The clinic entered the patient?s salary amount incorrectly in the billing system. There is not a system in place to properly detect and identify slides that may be incorrectly entered or applied. Effect: The patient may not receive the discount they are eligible for and noncompliance with Federal requirements and terms of the grant which may result in withdrawal or revocation of the grant given by the Federal agency. Recommendation: Management?s close supervision and review is the best means to ensure all requirements are met. We recommend implementation of a second level independent review over the demographic data and income verification information entered into the patient billing system in order to ensure the financial classification is correct.

2022-001: Significant Deficiency in Internal Control Over Compliance and Compliance Over Application of Sliding Fee Discounts Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Centers Cluster CFDA Number: 93.224 and 93.527 Criteria: The Health Centers Program, 42 U.S.C. ? 245b(k)(3)(G)(i) states that ?the center has prepared a schedule of fees or payments for the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient?s ability to pay.? Condition: During our testing of sliding fee discounts for health center, there were two instances in which the sliding fee was calculated incorrectly. Context: We randomly selected twenty-five sliding fee discounts to test for compliance. Two of the twenty-five sliding fee selections was incorrectly calculated. Questioned Costs: None Cause: The clinic entered the patient?s salary amount incorrectly in the billing system. There is not a system in place to properly detect and identify slides that may be incorrectly entered or applied. Effect: The patient may not receive the discount they are eligible for and noncompliance with Federal requirements and terms of the grant which may result in withdrawal or revocation of the grant given by the Federal agency. Recommendation: Management?s close supervision and review is the best means to ensure all requirements are met. We recommend implementation of a second level independent review over the demographic data and income verification information entered into the patient billing system in order to ensure the financial classification is correct.

2022-001: Significant Deficiency in Internal Control Over Compliance and Compliance Over Application of Sliding Fee Discounts Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Centers Cluster CFDA Number: 93.224 and 93.527 Criteria: The Health Centers Program, 42 U.S.C. ? 245b(k)(3)(G)(i) states that ?the center has prepared a schedule of fees or payments for the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient?s ability to pay.? Condition: During our testing of sliding fee discounts for health center, there were two instances in which the sliding fee was calculated incorrectly. Context: We randomly selected twenty-five sliding fee discounts to test for compliance. Two of the twenty-five sliding fee selections was incorrectly calculated. Questioned Costs: None Cause: The clinic entered the patient?s salary amount incorrectly in the billing system. There is not a system in place to properly detect and identify slides that may be incorrectly entered or applied. Effect: The patient may not receive the discount they are eligible for and noncompliance with Federal requirements and terms of the grant which may result in withdrawal or revocation of the grant given by the Federal agency. Recommendation: Management?s close supervision and review is the best means to ensure all requirements are met. We recommend implementation of a second level independent review over the demographic data and income verification information entered into the patient billing system in order to ensure the financial classification is correct.

2022-001: Significant Deficiency in Internal Control Over Compliance and Compliance Over Application of Sliding Fee Discounts Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Centers Cluster CFDA Number: 93.224 and 93.527 Criteria: The Health Centers Program, 42 U.S.C. ? 245b(k)(3)(G)(i) states that ?the center has prepared a schedule of fees or payments for the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient?s ability to pay.? Condition: During our testing of sliding fee discounts for health center, there were two instances in which the sliding fee was calculated incorrectly. Context: We randomly selected twenty-five sliding fee discounts to test for compliance. Two of the twenty-five sliding fee selections was incorrectly calculated. Questioned Costs: None Cause: The clinic entered the patient?s salary amount incorrectly in the billing system. There is not a system in place to properly detect and identify slides that may be incorrectly entered or applied. Effect: The patient may not receive the discount they are eligible for and noncompliance with Federal requirements and terms of the grant which may result in withdrawal or revocation of the grant given by the Federal agency. Recommendation: Management?s close supervision and review is the best means to ensure all requirements are met. We recommend implementation of a second level independent review over the demographic data and income verification information entered into the patient billing system in order to ensure the financial classification is correct.

2022-001: Significant Deficiency in Internal Control Over Compliance and Compliance Over Application of Sliding Fee Discounts Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Centers Cluster CFDA Number: 93.224 and 93.527 Criteria: The Health Centers Program, 42 U.S.C. ? 245b(k)(3)(G)(i) states that ?the center has prepared a schedule of fees or payments for the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient?s ability to pay.? Condition: During our testing of sliding fee discounts for health center, there were two instances in which the sliding fee was calculated incorrectly. Context: We randomly selected twenty-five sliding fee discounts to test for compliance. Two of the twenty-five sliding fee selections was incorrectly calculated. Questioned Costs: None Cause: The clinic entered the patient?s salary amount incorrectly in the billing system. There is not a system in place to properly detect and identify slides that may be incorrectly entered or applied. Effect: The patient may not receive the discount they are eligible for and noncompliance with Federal requirements and terms of the grant which may result in withdrawal or revocation of the grant given by the Federal agency. Recommendation: Management?s close supervision and review is the best means to ensure all requirements are met. We recommend implementation of a second level independent review over the demographic data and income verification information entered into the patient billing system in order to ensure the financial classification is correct.

2022-001: Significant Deficiency in Internal Control Over Compliance and Compliance Over Application of Sliding Fee Discounts Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Centers Cluster CFDA Number: 93.224 and 93.527 Criteria: The Health Centers Program, 42 U.S.C. ? 245b(k)(3)(G)(i) states that ?the center has prepared a schedule of fees or payments for the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient?s ability to pay.? Condition: During our testing of sliding fee discounts for health center, there were two instances in which the sliding fee was calculated incorrectly. Context: We randomly selected twenty-five sliding fee discounts to test for compliance. Two of the twenty-five sliding fee selections was incorrectly calculated. Questioned Costs: None Cause: The clinic entered the patient?s salary amount incorrectly in the billing system. There is not a system in place to properly detect and identify slides that may be incorrectly entered or applied. Effect: The patient may not receive the discount they are eligible for and noncompliance with Federal requirements and terms of the grant which may result in withdrawal or revocation of the grant given by the Federal agency. Recommendation: Management?s close supervision and review is the best means to ensure all requirements are met. We recommend implementation of a second level independent review over the demographic data and income verification information entered into the patient billing system in order to ensure the financial classification is correct.