Audit 310026

Information on the federal program: Assistance Listing Number 93.224, Health Center Program Cluster from the U.S. Department of Health and Human Services, Federal Award No. 6 H80CS33657 for project periods September 1, 2022 through April 30, 2025. Criteria or specific requirement: Health centers must prepare and apply a sliding fee discount schedule that incorporates the provisions of 42 CFR 51c.3032 through 56.303g to ensure that amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition: The audit of the major federal program identified errors in the application of sliding fee adjustments. Certain adjustments and write-offs were improperly coded as sliding fee adjustments. Questioned costs: Not applicable Context: Out of a population of 128 sliding fee adjustments, a sample of 13 adjustments were tested. Out of the 13 tested, 2 adjustments were inappropriately coded as sliding fee adjustments rather than other types of adjustments, such as prompt-pay discounts or hardship adjustments. Additionally, 2 adjustments were incorrectly calculated based on the Health Center’s approved sliding fee scales and the patient’s sliding fee application. A non-statistical sampling methodology was used to select the sample. Effect: The sliding fee adjustments were not appropriately applied or coded. Cause: Various adjustments, including the sliding fee, were not applied appropriately due to incorrect inputs in the Health Center’s system. Additionally, manual inputs required to calculate the sliding fee discounts resulted in errors in application of the sliding fee scales. Identification as a repeat finding: Not a repeat finding. Recommendation: We recommend that the Health Center implement a review process for sliding fee and other adjustments applied in the billing system, including review for the sliding fee application and relating supporting documents. Additionally, we recommend that a member of management with an understanding of the Health Center’s billing and sliding fee policies regularly review a sample of sliding fee adjustments in comparison to the Health Center’s sliding fee policy. Views of responsible officials and planned corrective actions: The Health Center agrees with the finding. See separate auditee document for planned corrective action.

Information on the federal program: Assistance Listing Number 93.224, Health Center Program Cluster from the U.S. Department of Health and Human Services, Federal Award No. 6 H80CS33657 for project periods September 1, 2022 through April 30, 2025. Criteria or specific requirement: Health centers must prepare and apply a sliding fee discount schedule that incorporates the provisions of 42 CFR 51c.3032 through 56.303g to ensure that amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition: The audit of the major federal program identified errors in the application of sliding fee adjustments. Certain adjustments and write-offs were improperly coded as sliding fee adjustments. Questioned costs: Not applicable Context: Out of a population of 128 sliding fee adjustments, a sample of 13 adjustments were tested. Out of the 13 tested, 2 adjustments were inappropriately coded as sliding fee adjustments rather than other types of adjustments, such as prompt-pay discounts or hardship adjustments. Additionally, 2 adjustments were incorrectly calculated based on the Health Center’s approved sliding fee scales and the patient’s sliding fee application. A non-statistical sampling methodology was used to select the sample. Effect: The sliding fee adjustments were not appropriately applied or coded. Cause: Various adjustments, including the sliding fee, were not applied appropriately due to incorrect inputs in the Health Center’s system. Additionally, manual inputs required to calculate the sliding fee discounts resulted in errors in application of the sliding fee scales. Identification as a repeat finding: Not a repeat finding. Recommendation: We recommend that the Health Center implement a review process for sliding fee and other adjustments applied in the billing system, including review for the sliding fee application and relating supporting documents. Additionally, we recommend that a member of management with an understanding of the Health Center’s billing and sliding fee policies regularly review a sample of sliding fee adjustments in comparison to the Health Center’s sliding fee policy. Views of responsible officials and planned corrective actions: The Health Center agrees with the finding. See separate auditee document for planned corrective action.

Information on the federal program: Assistance Listing Number 93.224, Health Center Program Cluster from the U.S. Department of Health and Human Services, Federal Award No. 6 H80CS33657 for project periods September 1, 2022 through April 30, 2025. Criteria or specific requirement: Health centers must prepare and apply a sliding fee discount schedule that incorporates the provisions of 42 CFR 51c.3032 through 56.303g to ensure that amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition: The audit of the major federal program identified errors in the application of sliding fee adjustments. Certain adjustments and write-offs were improperly coded as sliding fee adjustments. Questioned costs: Not applicable Context: Out of a population of 128 sliding fee adjustments, a sample of 13 adjustments were tested. Out of the 13 tested, 2 adjustments were inappropriately coded as sliding fee adjustments rather than other types of adjustments, such as prompt-pay discounts or hardship adjustments. Additionally, 2 adjustments were incorrectly calculated based on the Health Center’s approved sliding fee scales and the patient’s sliding fee application. A non-statistical sampling methodology was used to select the sample. Effect: The sliding fee adjustments were not appropriately applied or coded. Cause: Various adjustments, including the sliding fee, were not applied appropriately due to incorrect inputs in the Health Center’s system. Additionally, manual inputs required to calculate the sliding fee discounts resulted in errors in application of the sliding fee scales. Identification as a repeat finding: Not a repeat finding. Recommendation: We recommend that the Health Center implement a review process for sliding fee and other adjustments applied in the billing system, including review for the sliding fee application and relating supporting documents. Additionally, we recommend that a member of management with an understanding of the Health Center’s billing and sliding fee policies regularly review a sample of sliding fee adjustments in comparison to the Health Center’s sliding fee policy. Views of responsible officials and planned corrective actions: The Health Center agrees with the finding. See separate auditee document for planned corrective action.

Information on the federal program: Assistance Listing Number 93.224, Health Center Program Cluster from the U.S. Department of Health and Human Services, Federal Award No. 6 H80CS33657 for project periods September 1, 2022 through April 30, 2025. Criteria or specific requirement: Health centers must prepare and apply a sliding fee discount schedule that incorporates the provisions of 42 CFR 51c.3032 through 56.303g to ensure that amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition: The audit of the major federal program identified errors in the application of sliding fee adjustments. Certain adjustments and write-offs were improperly coded as sliding fee adjustments. Questioned costs: Not applicable Context: Out of a population of 128 sliding fee adjustments, a sample of 13 adjustments were tested. Out of the 13 tested, 2 adjustments were inappropriately coded as sliding fee adjustments rather than other types of adjustments, such as prompt-pay discounts or hardship adjustments. Additionally, 2 adjustments were incorrectly calculated based on the Health Center’s approved sliding fee scales and the patient’s sliding fee application. A non-statistical sampling methodology was used to select the sample. Effect: The sliding fee adjustments were not appropriately applied or coded. Cause: Various adjustments, including the sliding fee, were not applied appropriately due to incorrect inputs in the Health Center’s system. Additionally, manual inputs required to calculate the sliding fee discounts resulted in errors in application of the sliding fee scales. Identification as a repeat finding: Not a repeat finding. Recommendation: We recommend that the Health Center implement a review process for sliding fee and other adjustments applied in the billing system, including review for the sliding fee application and relating supporting documents. Additionally, we recommend that a member of management with an understanding of the Health Center’s billing and sliding fee policies regularly review a sample of sliding fee adjustments in comparison to the Health Center’s sliding fee policy. Views of responsible officials and planned corrective actions: The Health Center agrees with the finding. See separate auditee document for planned corrective action.