Audit 369094

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. 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. Effect or potential effect - The sliding fee adjustments were not appropriately applied. Questioned costs - Not applicable Context - Out of a population of 104 sliding fee adjustments, a sample of 11 adjustments were tested. Out of the 11 tested, 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. Identification as a repeat finding – Is 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. In 2024, the Health Center changed its sliding fee discount policy to be a flat rate discount rather than a percentage. The Health Center changed the policy to minimize future errors in the discount calculation. The 2 errors noted within the testing were for service dates prior to the policy change. The Health Center believes that the issue should be resolved going forward.

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 period September 1, 2022 through April 30, 2025. Criteria or specific requirement – Health Centers must comply with federal reporting requirements. Condition – The Organization did not have data to support certain line items reported on the Uniform Data System (UDS) report filed. Within the UDS report the amounts reported within table 8A within line 3 columns c and line 17 column c, and table 9E within line 1q column a were not supportable by underlying data. Cause – The Organization changed Electronic Medical Record systems resulting in a conversion of data mid-year. This added complexity in consolidating the correct reportable amounts. Effect or potential effect – Inaccurate filing of reports may result in the federal program not being properly monitored, thus resulting in potential noncompliance with program requirements. Questioned costs – Not applicable Context – Out of a population of 1 special report required to be submitted during the year under audit, 1 special report was tested. Identification as a repeat finding, if applicable – Not a repeat finding. Recommendation – We recommend management implement an additional level of review by someone with knowledge of the reporting requirements. Views of responsible officials and planned corrective actions – The Health Center agrees with the finding. Going forward, the Health Center will implement an additional layer of review and a retention policy over the data that supports final balances reported on the UDS report.