Finding: 2024-002 Sliding Fee Discounts
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303
Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by eligible patients are discounted based on the patient’s ability to pay. During compliance testing the following errors were noted:
• 9 patients were given discounts when applications were incomplete or expired
• 3 patients who qualified for discounts were given an incorrect discount
• 1 patient with income greater than 200% poverty was given a discount
• 1 patient with income less than 200% poverty was not given a discount
Cause: There were deficiencies in internal controls designed to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization’s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to certain patients.
Effect: Discounts were not properly applied to patient accounts.
Questioned Costs: None reported.
Context/Sampling: For 14 of 48 self-pay patients selected for testing, applications were incomplete or expired or incorrect discounts were given. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue.
Repeat Finding from Prior Year: Yes
Recommendation: It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate and that proper documentation is obtained. In addition, it is recommended that supervisory level personnel select and review a sample of sliding fee applications and discounts to ensure that staff are properly applying the discounts.
Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025
Finding: 2024-002 Sliding Fee Discounts
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303
Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by eligible patients are discounted based on the patient’s ability to pay. During compliance testing the following errors were noted:
• 9 patients were given discounts when applications were incomplete or expired
• 3 patients who qualified for discounts were given an incorrect discount
• 1 patient with income greater than 200% poverty was given a discount
• 1 patient with income less than 200% poverty was not given a discount
Cause: There were deficiencies in internal controls designed to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization’s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to certain patients.
Effect: Discounts were not properly applied to patient accounts.
Questioned Costs: None reported.
Context/Sampling: For 14 of 48 self-pay patients selected for testing, applications were incomplete or expired or incorrect discounts were given. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue.
Repeat Finding from Prior Year: Yes
Recommendation: It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate and that proper documentation is obtained. In addition, it is recommended that supervisory level personnel select and review a sample of sliding fee applications and discounts to ensure that staff are properly applying the discounts.
Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025
Finding: 2024-002 Sliding Fee Discounts
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303
Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by eligible patients are discounted based on the patient’s ability to pay. During compliance testing the following errors were noted:
• 9 patients were given discounts when applications were incomplete or expired
• 3 patients who qualified for discounts were given an incorrect discount
• 1 patient with income greater than 200% poverty was given a discount
• 1 patient with income less than 200% poverty was not given a discount
Cause: There were deficiencies in internal controls designed to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization’s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to certain patients.
Effect: Discounts were not properly applied to patient accounts.
Questioned Costs: None reported.
Context/Sampling: For 14 of 48 self-pay patients selected for testing, applications were incomplete or expired or incorrect discounts were given. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue.
Repeat Finding from Prior Year: Yes
Recommendation: It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate and that proper documentation is obtained. In addition, it is recommended that supervisory level personnel select and review a sample of sliding fee applications and discounts to ensure that staff are properly applying the discounts.
Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025
Finding: 2024-003 Cash Management – Federal Grants
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Cash Management, 45 CFR 75.305
Condition: During the year, the Organization made three draws of federal funds that were not disbursed in a timely manner for program expenditures. The Organization is required to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes.
Cause: The Organization made draws of federal grant funds in advance of making the qualifying expenditures.
Effect: Although expenditures were made prior to June 30, 2024, the Organization did not minimize the time elapsing between transfer of funds from the United States Treasury and the disbursement for expenditures.
Questioned Costs: None reported.
Context/Sampling: The finding appears to be a systemic issue.
Repeat Finding from Prior Year: No
Recommendation: Efforts should be made to ensure advance draws of federal funds do not occur.
Views of Responsible Officials: The Organization understands the requirements to disburse federal funds in a timely manner. Procedures will be established to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes by the Organization.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025
Finding: 2024-003 Cash Management – Federal Grants
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Cash Management, 45 CFR 75.305
Condition: During the year, the Organization made three draws of federal funds that were not disbursed in a timely manner for program expenditures. The Organization is required to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes.
Cause: The Organization made draws of federal grant funds in advance of making the qualifying expenditures.
Effect: Although expenditures were made prior to June 30, 2024, the Organization did not minimize the time elapsing between transfer of funds from the United States Treasury and the disbursement for expenditures.
Questioned Costs: None reported.
Context/Sampling: The finding appears to be a systemic issue.
Repeat Finding from Prior Year: No
Recommendation: Efforts should be made to ensure advance draws of federal funds do not occur.
Views of Responsible Officials: The Organization understands the requirements to disburse federal funds in a timely manner. Procedures will be established to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes by the Organization.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025
Finding: 2024-003 Cash Management – Federal Grants
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Cash Management, 45 CFR 75.305
Condition: During the year, the Organization made three draws of federal funds that were not disbursed in a timely manner for program expenditures. The Organization is required to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes.
Cause: The Organization made draws of federal grant funds in advance of making the qualifying expenditures.
Effect: Although expenditures were made prior to June 30, 2024, the Organization did not minimize the time elapsing between transfer of funds from the United States Treasury and the disbursement for expenditures.
Questioned Costs: None reported.
Context/Sampling: The finding appears to be a systemic issue.
Repeat Finding from Prior Year: No
Recommendation: Efforts should be made to ensure advance draws of federal funds do not occur.
Views of Responsible Officials: The Organization understands the requirements to disburse federal funds in a timely manner. Procedures will be established to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes by the Organization.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025
Finding: 2024-002 Sliding Fee Discounts
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303
Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by eligible patients are discounted based on the patient’s ability to pay. During compliance testing the following errors were noted:
• 9 patients were given discounts when applications were incomplete or expired
• 3 patients who qualified for discounts were given an incorrect discount
• 1 patient with income greater than 200% poverty was given a discount
• 1 patient with income less than 200% poverty was not given a discount
Cause: There were deficiencies in internal controls designed to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization’s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to certain patients.
Effect: Discounts were not properly applied to patient accounts.
Questioned Costs: None reported.
Context/Sampling: For 14 of 48 self-pay patients selected for testing, applications were incomplete or expired or incorrect discounts were given. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue.
Repeat Finding from Prior Year: Yes
Recommendation: It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate and that proper documentation is obtained. In addition, it is recommended that supervisory level personnel select and review a sample of sliding fee applications and discounts to ensure that staff are properly applying the discounts.
Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025
Finding: 2024-002 Sliding Fee Discounts
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303
Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by eligible patients are discounted based on the patient’s ability to pay. During compliance testing the following errors were noted:
• 9 patients were given discounts when applications were incomplete or expired
• 3 patients who qualified for discounts were given an incorrect discount
• 1 patient with income greater than 200% poverty was given a discount
• 1 patient with income less than 200% poverty was not given a discount
Cause: There were deficiencies in internal controls designed to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization’s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to certain patients.
Effect: Discounts were not properly applied to patient accounts.
Questioned Costs: None reported.
Context/Sampling: For 14 of 48 self-pay patients selected for testing, applications were incomplete or expired or incorrect discounts were given. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue.
Repeat Finding from Prior Year: Yes
Recommendation: It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate and that proper documentation is obtained. In addition, it is recommended that supervisory level personnel select and review a sample of sliding fee applications and discounts to ensure that staff are properly applying the discounts.
Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025
Finding: 2024-002 Sliding Fee Discounts
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303
Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by eligible patients are discounted based on the patient’s ability to pay. During compliance testing the following errors were noted:
• 9 patients were given discounts when applications were incomplete or expired
• 3 patients who qualified for discounts were given an incorrect discount
• 1 patient with income greater than 200% poverty was given a discount
• 1 patient with income less than 200% poverty was not given a discount
Cause: There were deficiencies in internal controls designed to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization’s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to certain patients.
Effect: Discounts were not properly applied to patient accounts.
Questioned Costs: None reported.
Context/Sampling: For 14 of 48 self-pay patients selected for testing, applications were incomplete or expired or incorrect discounts were given. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue.
Repeat Finding from Prior Year: Yes
Recommendation: It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate and that proper documentation is obtained. In addition, it is recommended that supervisory level personnel select and review a sample of sliding fee applications and discounts to ensure that staff are properly applying the discounts.
Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025
Finding: 2024-003 Cash Management – Federal Grants
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Cash Management, 45 CFR 75.305
Condition: During the year, the Organization made three draws of federal funds that were not disbursed in a timely manner for program expenditures. The Organization is required to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes.
Cause: The Organization made draws of federal grant funds in advance of making the qualifying expenditures.
Effect: Although expenditures were made prior to June 30, 2024, the Organization did not minimize the time elapsing between transfer of funds from the United States Treasury and the disbursement for expenditures.
Questioned Costs: None reported.
Context/Sampling: The finding appears to be a systemic issue.
Repeat Finding from Prior Year: No
Recommendation: Efforts should be made to ensure advance draws of federal funds do not occur.
Views of Responsible Officials: The Organization understands the requirements to disburse federal funds in a timely manner. Procedures will be established to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes by the Organization.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025
Finding: 2024-003 Cash Management – Federal Grants
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Cash Management, 45 CFR 75.305
Condition: During the year, the Organization made three draws of federal funds that were not disbursed in a timely manner for program expenditures. The Organization is required to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes.
Cause: The Organization made draws of federal grant funds in advance of making the qualifying expenditures.
Effect: Although expenditures were made prior to June 30, 2024, the Organization did not minimize the time elapsing between transfer of funds from the United States Treasury and the disbursement for expenditures.
Questioned Costs: None reported.
Context/Sampling: The finding appears to be a systemic issue.
Repeat Finding from Prior Year: No
Recommendation: Efforts should be made to ensure advance draws of federal funds do not occur.
Views of Responsible Officials: The Organization understands the requirements to disburse federal funds in a timely manner. Procedures will be established to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes by the Organization.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025
Finding: 2024-003 Cash Management – Federal Grants
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. 93.224 and 93.527
Criteria: Cash Management, 45 CFR 75.305
Condition: During the year, the Organization made three draws of federal funds that were not disbursed in a timely manner for program expenditures. The Organization is required to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes.
Cause: The Organization made draws of federal grant funds in advance of making the qualifying expenditures.
Effect: Although expenditures were made prior to June 30, 2024, the Organization did not minimize the time elapsing between transfer of funds from the United States Treasury and the disbursement for expenditures.
Questioned Costs: None reported.
Context/Sampling: The finding appears to be a systemic issue.
Repeat Finding from Prior Year: No
Recommendation: Efforts should be made to ensure advance draws of federal funds do not occur.
Views of Responsible Officials: The Organization understands the requirements to disburse federal funds in a timely manner. Procedures will be established to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes by the Organization.
Contact Person: Shantelle Simpson, President & CEO
Anticipated Date of Completion: January 31, 2025