Finding 2023-001: Special Tests and Provisions - Significant Deficiency – Incorrect Application of the Sliding Scale
Federal Assistance Listing Number: 93.224/93.527- Health Center Program Cluster
[including Covid-19 funds]
Federal Agency: U.S. Department of Health and Human Services
Federal Award Numbers: H80CS00313-13-12; H8FCS41390-01-00, H2ECS45521-01-00
Federal Award Year: January 1, 2023- December 31, 2023
Pass-Through Entity: Sun River Health Care
Criteria: Under 42 CFR Sections 51c.303(e), (f) and (g), health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay. To verify this criteria, the compliance supplement has the suggested audit procedures which require the auditor to review a sample of patients treated. HHLI should maintain patient files to support the patient's eligibility and that the patient charges were appropriately adjusted based on income and family size by appropriately applying HHLI's sliding fee discount schedule.
Questioned Cost: None
Condition: 2 out of 43 selected patients receiving healthcare under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category.
Context: We recalculated the annual income thresholds utilizing the patient files to validate the sliding fee scale in which the patients were categorized. 2 out of 43 selected patients receiving healthcare services under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category. This was not a statistically valid sample.
Effect: 2 out of 43 patients were not charged the appropriate fees based on their income levels. Incorrect payment amount was received per the sliding fee scale. This is a significant deficiency in internal controls.
Cause: A review was not performed properly to verify that annual patient income was input correctly.
Recommendation: We recommend that HHLI continue to implement procedures to ensure that the sliding fee scale is appropriately charged to every patient and that an annual verification is performed. Procedures should also be implemented to validate the accuracy of the annual patient income for sliding scale categorization purposes.
Finding 2023-001: Special Tests and Provisions - Significant Deficiency – Incorrect Application of the Sliding Scale
Federal Assistance Listing Number: 93.224/93.527- Health Center Program Cluster
[including Covid-19 funds]
Federal Agency: U.S. Department of Health and Human Services
Federal Award Numbers: H80CS00313-13-12; H8FCS41390-01-00, H2ECS45521-01-00
Federal Award Year: January 1, 2023- December 31, 2023
Pass-Through Entity: Sun River Health Care
Criteria: Under 42 CFR Sections 51c.303(e), (f) and (g), health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay. To verify this criteria, the compliance supplement has the suggested audit procedures which require the auditor to review a sample of patients treated. HHLI should maintain patient files to support the patient's eligibility and that the patient charges were appropriately adjusted based on income and family size by appropriately applying HHLI's sliding fee discount schedule.
Questioned Cost: None
Condition: 2 out of 43 selected patients receiving healthcare under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category.
Context: We recalculated the annual income thresholds utilizing the patient files to validate the sliding fee scale in which the patients were categorized. 2 out of 43 selected patients receiving healthcare services under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category. This was not a statistically valid sample.
Effect: 2 out of 43 patients were not charged the appropriate fees based on their income levels. Incorrect payment amount was received per the sliding fee scale. This is a significant deficiency in internal controls.
Cause: A review was not performed properly to verify that annual patient income was input correctly.
Recommendation: We recommend that HHLI continue to implement procedures to ensure that the sliding fee scale is appropriately charged to every patient and that an annual verification is performed. Procedures should also be implemented to validate the accuracy of the annual patient income for sliding scale categorization purposes.
Finding 2023-001: Special Tests and Provisions - Significant Deficiency – Incorrect Application of the Sliding Scale
Federal Assistance Listing Number: 93.224/93.527- Health Center Program Cluster
[including Covid-19 funds]
Federal Agency: U.S. Department of Health and Human Services
Federal Award Numbers: H80CS00313-13-12; H8FCS41390-01-00, H2ECS45521-01-00
Federal Award Year: January 1, 2023- December 31, 2023
Pass-Through Entity: Sun River Health Care
Criteria: Under 42 CFR Sections 51c.303(e), (f) and (g), health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay. To verify this criteria, the compliance supplement has the suggested audit procedures which require the auditor to review a sample of patients treated. HHLI should maintain patient files to support the patient's eligibility and that the patient charges were appropriately adjusted based on income and family size by appropriately applying HHLI's sliding fee discount schedule.
Questioned Cost: None
Condition: 2 out of 43 selected patients receiving healthcare under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category.
Context: We recalculated the annual income thresholds utilizing the patient files to validate the sliding fee scale in which the patients were categorized. 2 out of 43 selected patients receiving healthcare services under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category. This was not a statistically valid sample.
Effect: 2 out of 43 patients were not charged the appropriate fees based on their income levels. Incorrect payment amount was received per the sliding fee scale. This is a significant deficiency in internal controls.
Cause: A review was not performed properly to verify that annual patient income was input correctly.
Recommendation: We recommend that HHLI continue to implement procedures to ensure that the sliding fee scale is appropriately charged to every patient and that an annual verification is performed. Procedures should also be implemented to validate the accuracy of the annual patient income for sliding scale categorization purposes.
Finding 2023-001: Special Tests and Provisions - Significant Deficiency – Incorrect Application of the Sliding Scale
Federal Assistance Listing Number: 93.224/93.527- Health Center Program Cluster
[including Covid-19 funds]
Federal Agency: U.S. Department of Health and Human Services
Federal Award Numbers: H80CS00313-13-12; H8FCS41390-01-00, H2ECS45521-01-00
Federal Award Year: January 1, 2023- December 31, 2023
Pass-Through Entity: Sun River Health Care
Criteria: Under 42 CFR Sections 51c.303(e), (f) and (g), health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay. To verify this criteria, the compliance supplement has the suggested audit procedures which require the auditor to review a sample of patients treated. HHLI should maintain patient files to support the patient's eligibility and that the patient charges were appropriately adjusted based on income and family size by appropriately applying HHLI's sliding fee discount schedule.
Questioned Cost: None
Condition: 2 out of 43 selected patients receiving healthcare under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category.
Context: We recalculated the annual income thresholds utilizing the patient files to validate the sliding fee scale in which the patients were categorized. 2 out of 43 selected patients receiving healthcare services under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category. This was not a statistically valid sample.
Effect: 2 out of 43 patients were not charged the appropriate fees based on their income levels. Incorrect payment amount was received per the sliding fee scale. This is a significant deficiency in internal controls.
Cause: A review was not performed properly to verify that annual patient income was input correctly.
Recommendation: We recommend that HHLI continue to implement procedures to ensure that the sliding fee scale is appropriately charged to every patient and that an annual verification is performed. Procedures should also be implemented to validate the accuracy of the annual patient income for sliding scale categorization purposes.
Finding 2023-001: Special Tests and Provisions - Significant Deficiency – Incorrect Application of the Sliding Scale
Federal Assistance Listing Number: 93.224/93.527- Health Center Program Cluster
[including Covid-19 funds]
Federal Agency: U.S. Department of Health and Human Services
Federal Award Numbers: H80CS00313-13-12; H8FCS41390-01-00, H2ECS45521-01-00
Federal Award Year: January 1, 2023- December 31, 2023
Pass-Through Entity: Sun River Health Care
Criteria: Under 42 CFR Sections 51c.303(e), (f) and (g), health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay. To verify this criteria, the compliance supplement has the suggested audit procedures which require the auditor to review a sample of patients treated. HHLI should maintain patient files to support the patient's eligibility and that the patient charges were appropriately adjusted based on income and family size by appropriately applying HHLI's sliding fee discount schedule.
Questioned Cost: None
Condition: 2 out of 43 selected patients receiving healthcare under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category.
Context: We recalculated the annual income thresholds utilizing the patient files to validate the sliding fee scale in which the patients were categorized. 2 out of 43 selected patients receiving healthcare services under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category. This was not a statistically valid sample.
Effect: 2 out of 43 patients were not charged the appropriate fees based on their income levels. Incorrect payment amount was received per the sliding fee scale. This is a significant deficiency in internal controls.
Cause: A review was not performed properly to verify that annual patient income was input correctly.
Recommendation: We recommend that HHLI continue to implement procedures to ensure that the sliding fee scale is appropriately charged to every patient and that an annual verification is performed. Procedures should also be implemented to validate the accuracy of the annual patient income for sliding scale categorization purposes.
Finding 2023-001: Special Tests and Provisions - Significant Deficiency – Incorrect Application of the Sliding Scale
Federal Assistance Listing Number: 93.224/93.527- Health Center Program Cluster
[including Covid-19 funds]
Federal Agency: U.S. Department of Health and Human Services
Federal Award Numbers: H80CS00313-13-12; H8FCS41390-01-00, H2ECS45521-01-00
Federal Award Year: January 1, 2023- December 31, 2023
Pass-Through Entity: Sun River Health Care
Criteria: Under 42 CFR Sections 51c.303(e), (f) and (g), health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay. To verify this criteria, the compliance supplement has the suggested audit procedures which require the auditor to review a sample of patients treated. HHLI should maintain patient files to support the patient's eligibility and that the patient charges were appropriately adjusted based on income and family size by appropriately applying HHLI's sliding fee discount schedule.
Questioned Cost: None
Condition: 2 out of 43 selected patients receiving healthcare under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category.
Context: We recalculated the annual income thresholds utilizing the patient files to validate the sliding fee scale in which the patients were categorized. 2 out of 43 selected patients receiving healthcare services under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category. This was not a statistically valid sample.
Effect: 2 out of 43 patients were not charged the appropriate fees based on their income levels. Incorrect payment amount was received per the sliding fee scale. This is a significant deficiency in internal controls.
Cause: A review was not performed properly to verify that annual patient income was input correctly.
Recommendation: We recommend that HHLI continue to implement procedures to ensure that the sliding fee scale is appropriately charged to every patient and that an annual verification is performed. Procedures should also be implemented to validate the accuracy of the annual patient income for sliding scale categorization purposes.