Audit 390491

Federal Program: U.S. Department of Health and Human Services Health Center Program Cluster: Grants for New and Expanded Services Under the Health Center Program, Assistance Listing 93.527 Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), Assistance Listing 93.224 Criteria: The Health Center must comply with 42 USC 254b(k)(E), (F) and (G); 42 CFR sections 51c.303(e); (f) and (g), and 42 CFR sections 56.303(e), (f), and (g). Condition: During testing of the sliding fee discount, we selected a sample of 25 charges that a sliding scale fee was applied. In one instance, a patient qualified for an 80% sliding fee discount, which was approved on November 25, 2024. However, on November 26, 2024, income information was entered into the Informational Technology (IT) system indicating the patient qualified for a 100% discount. This updated income information was not approved and no supporting documentation was maintained. The entity's system relies on the most recent income information, regardless of approval status. We tested an additional 15 samples and did not find any additional errors. Cause: The Health Center's IT system is not configured to restrict the application of unapproved income or sliding fee discount information. Effect: Unapproved sliding fee discounts were applied to the patient's charges that were not allowable. Continued use of the current system configuration increases the risk that costs charged to the federal award may not comply with federal eligibility and allowability requirements. Questioned Costs: Total questioned costs related to this finding were $8 for the total encounter. Recommendation: We recommend that management modify their IT system to prevent unapproved income information or sliding fee applications from being applied to patients accounts and implement a documented review process to ensure sliding fee discounts are applied only after approval.