Current Year Findings Corrective Action Plan 2022-001 Improper application of sliding fee discount CFDA Nos. ? 93.224 and 93.527 Federal Award ID # and Year ? 2 H80CS00744-19-00 Program Year 2022 Federal Agency Name: U.S. Department of Health and Human Services Type of finding Significant deficiency...
Current Year Findings Corrective Action Plan 2022-001 Improper application of sliding fee discount CFDA Nos. ? 93.224 and 93.527 Federal Award ID # and Year ? 2 H80CS00744-19-00 Program Year 2022 Federal Agency Name: U.S. Department of Health and Human Services Type of finding Significant deficiency in internal control over compliance (recurring) Criteria or Specific Requirement Special Tests and Provisions: Sliding Fee Discounts per Title 42 Chapter 1 Subchapter D Section 51c303(f) Condition The Organization?s sliding fee program provides discounts on patient services based upon the individual?s level of income. However, the Organization applied the incorrect discount based upon the individual?s income per the Organizations sliding fee discount policy. Cause Clerical error in updating and applying the sliding fee category in the billing system for the patient. Effect or Potential Effect Improper sliding fee discounts given to patients. Questioned Costs None Context or Perspective Information A sample of 40 patients were tested out of the total population of 1,994 encounters. The sampling methodology used is not statistically valid. Three patients received the incorrect sliding fee discount based upon their income level. Recommendation We recommend that the Organization implement a verification process to ensure the sliding fee discounts being applied are in accordance with their sliding fee policy. Corrective Action Plan Hidalgo Medical Services will implement a verification process to ensure the sliding fee discounts are applied in accordance with the current sliding fee policy. The Director of Family Support Services will randomly select at least 30% of patients qualified each week to ensure accuracy and all proper documentation is obtained (the new auditing requirement will occur immediately). Additionally, all errors will be corrected immediately. The Director of Family Support Services will report each month to the Chief Support Officer, Chief Financial Officer, and Chief Executive Officers any findings and required correction, if applicable. A comprehensive re-training of current Community Health Workers (CHWs) is to occur by December 2022. A training manual is to be developed, to include competency validation for each CHW, and the new training model will be used for all future CHWs. Person Responsible: Lucy Verdugo, Family Support and Credentialing Director; Donna Sandoval, CHW Administrative Supervisor; and Andrea Montoya, Chief Support Officer Anticipated Completion Date: December 31, 2022.