Audit 372572

Health Center Program Cluster; Federal Assistance Listing No. 93.224 and 93.527; Department of Health and Human Services; H8024168, budget period 6/1/2024 – 5/31/2025 Criteria or specific requirement: Special Tests and Provisions – 42 CFR, Part 51.303(f) and (g). Health Centers receiving funds under the Health Center Program Cluster are required to prepare a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts adjusted on the basis of the patient’s ability to pay, to make every reasonable effort, including the establishment of systems for eligibility determination, billing and collection, and to secure from patient payments for services in accordance with the schedule of fees and discounts. Condition: We noted during our testing of compliance with federal awards that the Health Center did not properly apply the sliding fee discounts approved by the board of directors for two patients out of a sample of 25 patients. Cause: The Health Center did not comply with their sliding fee policy on retaining supporting documentation and an error in inputting the family size information. Effect or potential effect: Discounts were not properly applied to patient accounts. Questioned cost: None Context: From a total of 7,499 sliding fee discounts for the period, 25 discounts were selected for testing. This sample was not, and was not intended to be, a statistically valid sample. The Health Center’s management did prepare a schedule of discounts adjusted on the basis of the patient’s ability to pay; such schedule was periodically updated and approved by the Health Center’s board of directors and the schedule was uploaded into the Health Center’s billing system. For two of the 25 accounts selected for testing, the account had an incorrect discount applied or lack of supporting documentation. Identification as a repeat finding, if applicable: Not a repeat finding. Recommendation: We recommend management continue their internal review process and increase training provided to their revenue cycle team members. Views of responsible officials and planned corrective actions: Management acknowledged the sliding fee adjustment errors. Management will add an additional layer of review over the application of the sliding fee scale. Further, the Health Center will continue their periodic reviews of sliding fee adjustments throughout the year for accuracy.