Finding Text
Criteria: Recipients of Federal awards must establish and maintain effective internal controls over special tests and provisions and maintain evidence that such internal controls were performed.
Condition: During our testing of sliding fee discounts, we noted that 14 out of 40 sampled financial records reflected an incorrect discount.
Cause: Front office staff collect completed income verification forms and any relevant income documentation or Patient Income Self Attestation forms from patients applying for a sliding fee discount. The Corporation did not implement controls to include review and approval by an individual other than the front office staff of the accuracy of provided discounts that were entered into the patient billing system.
Effect or Potential Effect: Sliding fee discounts provided to patients may be inaccurate based on the individual’s or family’s income.
Questioned costs: None
Context: We tested a sample of 40 financial records for controls over patients treated during the audit period to determine whether patient charges were ppropriately adjusted based on income and family size. It was noted the Corporation did not implement controls to review the accuracy of income verification forms and the data entered the patient billing system. As a result, 14 of the 40 financial records selected reflected an incorrect discount. This is a condition identified per review of the Corporation’s compliance with specified requirements using a statistically valid sample.
Repeat finding: This is a repeat finding from prior year. This was reported as finding 2021-011 in the 2021 report.
Recommendation: We recommend the Corporation revise the Sliding Fee Discount Program policy to include a level of review of patient’s income verification forms and related documentation and the accuracy of the applicable discount entered into the patient billing system.
View of Responsible Officials: Due to turnover of several key financial executives and revenue cycle personnel, the Corporation did not perform or document evidence of approval for provided sliding fee discounts to individuals or families.