Audit 410678

Information on the federal program – Assistance Listing Number 93.224/93.527, Health Center Program Cluster from the U.S. Department of Health and Human Services, Federal Award No. 6 H80CS00581 for project period March 1, 2025 through February 28, 2026. Criteria or specific requirement – Health Centers must prepare and apply a sliding fee discount schedule that incorporates the provisions of 42 CFR 51c.303e 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 – The sliding fee calculation was improperly set up within the Electronic Health Record System. Effect or potential effect – Inaccurate application of sliding fee adjustments may result in potential noncompliance with program requirements. Questioned costs – Not applicable. Context – Out of a population of 14,158 sliding fee adjustments, a sample of 25 adjustments were tested. Out of the 25 tested, 3 adjustments were incorrectly calculated based on the Organization’s 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, if applicable – Is a repeat finding. Recommendation – We recommend that the Organization perform a review of the calculation of the sliding fee adjustments within the Electronic Health Record system to ensure it is properly set up. Additionally, we recommend that a member of management with an understanding of the Organization’s billing and sliding fee policies regularly review a sample of sliding fee adjustments in comparison to the Organization’s sliding fee policy. Views of responsible officials and planned corrective actions – The sliding fee adjustment errors resulted from an error in the set up of the automated adjustment calculation within the Electronic Health Record system. Management has identified the error with plans to ensure correction within the system. Further, the Organization will implement a process to periodically review sliding fee adjustments throughout the year for accuracy.

Information on the federal program – Assistance Listing Number 93.224/93.527, Health Center Program Cluster from the U.S. Department of Health and Human Services, Federal Award No. 6 H80CS00581 for project period March 1, 2025 through February 28, 2026. 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. The amount reported within table 5 lines 8 and 10a in columns b and b2 along with table 8A line 17 column c was not supportable by underlying data. Cause – There was a lack of detailed review of the submitted report by someone with knowledge of the reporting requirements. 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 that was required to be submitted during the year under audit (UDS), we selected this 1 report for testing. Identification as a repeat finding, if applicable – Is 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 – To ensure compliance with federal reporting standards, the Organization will require a secondary review of all federal reports submitted to granting agencies. The designated secondary reviewer shall be an individual that has strong knowledge of the reporting requirements.