Audit 347499

Finding 2024-001: Sliding Fee Discount Federal Agency: Department of Health and Human Services Federal Program Name: Health Center Program Cluster Assistance Listing Number: 93.224 Federal Award Identification Number and Year: H8000298 2023/2024 Award Period: 3/1/2023 – 2/28/2024, 3/1/2024 – 2/28/2025 Type of Finding: • Material Weakness in Internal Control over Compliance Criteria or specific requirement: Health centers receiving this funding must prepare and apply a sliding fee discount so that the amounts owed for health centers services by eligible patients are adjusted based on the patients ability to pay. Condition: Heath Centers receiving this funding must prepare and apply a sliding fee discount so that the amounts owed for health centers services by eligible patients are adjusted (discounted) based on the patient’s ability to pay using the Federal Poverty Guidelines (FPG). The Centers are required to apply a full discount to fees for services to individuals with income at or below 100% FPG and prorated for incomes between 100% and 200% of the FPG. Questioned costs: None Context: In our sample of 25 patient account, sliding fee scale was applied incorrectly to 4 patients and proper documentation of applications was not maintained. Cause: In our sample of twenty-five (25) patient accounts, the Organization applied the wrong sliding fee scale to four (4) patients and proper documentation of sliding fee applications was not maintained as there were not proper controls in place. Effect: The Organization could charge an incorrect fee or apply a discount in error. Repeat Finding: No Recommendation: CLA recommends that the Organization continue to perform quality control inspections of sliding fee documentation and eligibility determinations to improve results. Views of responsible officials: Management agrees with the finding. HRSA Health Center Program Compliance requirements for the Sliding Fee Discount Program will be ongoing. The quality management and compliance department will increase frequency of internal audits. Front desk staff and their immediate supervisors will be provided with feedback regarding the results. Plans for required performance improvement, including the provision of additional training, will be developed and monitored for completion. Instances of repeated deficiencies will result in corrective action. All front desk staff will be required to participate in mandatory biannual training pertaining to the Sliding Fee Discount Program. The revenue cycle manager is communicating directly with the supervisors of the front desk staff whenever any errors are found in the revenue cycle department to ensure appropriate action is taken.

Finding 2024-001: Sliding Fee Discount Federal Agency: Department of Health and Human Services Federal Program Name: Health Center Program Cluster Assistance Listing Number: 93.224 Federal Award Identification Number and Year: H8000298 2023/2024 Award Period: 3/1/2023 – 2/28/2024, 3/1/2024 – 2/28/2025 Type of Finding: • Material Weakness in Internal Control over Compliance Criteria or specific requirement: Health centers receiving this funding must prepare and apply a sliding fee discount so that the amounts owed for health centers services by eligible patients are adjusted based on the patients ability to pay. Condition: Heath Centers receiving this funding must prepare and apply a sliding fee discount so that the amounts owed for health centers services by eligible patients are adjusted (discounted) based on the patient’s ability to pay using the Federal Poverty Guidelines (FPG). The Centers are required to apply a full discount to fees for services to individuals with income at or below 100% FPG and prorated for incomes between 100% and 200% of the FPG. Questioned costs: None Context: In our sample of 25 patient account, sliding fee scale was applied incorrectly to 4 patients and proper documentation of applications was not maintained. Cause: In our sample of twenty-five (25) patient accounts, the Organization applied the wrong sliding fee scale to four (4) patients and proper documentation of sliding fee applications was not maintained as there were not proper controls in place. Effect: The Organization could charge an incorrect fee or apply a discount in error. Repeat Finding: No Recommendation: CLA recommends that the Organization continue to perform quality control inspections of sliding fee documentation and eligibility determinations to improve results. Views of responsible officials: Management agrees with the finding. HRSA Health Center Program Compliance requirements for the Sliding Fee Discount Program will be ongoing. The quality management and compliance department will increase frequency of internal audits. Front desk staff and their immediate supervisors will be provided with feedback regarding the results. Plans for required performance improvement, including the provision of additional training, will be developed and monitored for completion. Instances of repeated deficiencies will result in corrective action. All front desk staff will be required to participate in mandatory biannual training pertaining to the Sliding Fee Discount Program. The revenue cycle manager is communicating directly with the supervisors of the front desk staff whenever any errors are found in the revenue cycle department to ensure appropriate action is taken.