Audit 369345

Finding 2024-001 – Incorrect Application of Sliding Fee Discounts Assistance Listing Number (ALN): 93.224 and 93.527 Assistance Listing Program Title: Health Center Program Cluster Federal Agency: U.S. Department of Health and Human Services (HHS) Passed Through Entity: Not applicable Federal Award Numbers: H80CS10609, H2ECS45622, H8HCS46150, H8LCS51906 Federal Award Year: May 1, 2023 to April 30, 2024 May 1, 2024 to April 30, 2025 September 1, 2023 to December 31, 2024 September 1, 2024 to August 31, 2025 Compliance Requirement: Special Tests and Provisions – Sliding Fee Discounts Criteria or Specific Requirements Section N (1) Special Tests and Provisions – Sliding Fee Discounts of Part 4 Agency Program Requirements of the Health Center Program Cluster, states that “Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges and designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted based on the patient’s ability to pay. The patient’s ability to pay is determined based on the official poverty guidelines, as revised annually by the U.S. Department of Health and Human Services (HHS). The poverty guidelines are issued each year in the Federal Register and HHS maintains a web page that provides the poverty guidelines.” Condition UMMA determines the amount of fees to be charged to a patient based on the patient’s income, expenses, and number of dependents in conjunction with the sliding fee schedule. Of the 25 patients selected for testwork, we noted three patients who were inadvertently assigned an incorrect poverty level by the clinic staff, which resulted in the incorrect calculation of the sliding fee amount by the Electronic Medical Record (EMR) system. These errors resulted in overcharging the patients by a total of $15 ($5 for each patient). Questioned Costs None. Causes and Effect The above errors were attributed to the following: • Errors by staff in properly utilizing the sliding fee schedule • Insufficient supervisor review process • Lack of sufficient training Such errors may result in an incorrect determination of the patient’s ability to pay, and incorrect amounts charged to patients. Recommendation We recommend that UMMA strengthen its internal control procedures to ensure the accurate determination and application of the sliding fee discounts. Specifically, UMMA should provide additional training to staff involved in the sliding fee process, supervisory review of sliding fee determinations made by staff, and ensure that appropriate individuals are monitoring and reviewing UMMA’s compliance with the program requirements. This will help ensure that patients are charged the proper sliding fee and that program goals and objectives are met. Views of Responsible Officials and Planned Corrective Actions UMMA’s Management will implement ongoing front desk training to assist staff in recognizing incorrect sliding fee assignments or possible errors in patient fees. Additionally, UMMA will conduct routine audits of Sliding Fee Discount program along and consultation of EMR system to ensure all system workflows are operating per guidelines. Responsible Official Alejandra Murillo, Chief Financial Officer Expected Implementation Date December 31, 2025