Finding Text
Finding 2024-001 – Special Tests and Provisions – Significant deficiency in Internal Control
over Compliance
Federal Program: U.S. Department of Health and Human Services Health Center
Program Cluster (Federal Assistance Listing # 93.224/93.527)
Federal Agency: U.S. Department of Health and Human Services
Award Year: 2023-2024
Criteria:
The recipient is required to comply with specific federal regulations and provisions outlined in 2 CFR Part
200, particularly those related to special tests and provisions for the Health Center Program Cluster. This
includes maintaining an effective internal control environment to ensure sliding fee discounts are applied
to patient charges consistent with the recipients sliding fee discount schedule.
Condition/Cause:
During the audit, it was identified that LifeLong did not retain underlying data in accordance with policy to
support the sliding fee scale discount based on the patients’ family size or income. There were several
turnovers in the department which resulted in inconsistent application of the sliding scale policies and
insufficient staff training on eligibility determination and documentation requirements.
Effect:
Certain patients may have been billed amounts in excess of and less than the amounts defined by the
sliding fee discount schedule.
Questioned costs:
Not applicable.
Context:
We selected a sample of 40 patient visits from a statistically valid population of patients potentially eligible
for benefits under the sliding fee schedule during the fiscal year ended June 30, 2024. In 8 out of 40
samples tested, LifeLong was unable to locate underlying support required per their policy.
Repeat Finding:
This is not a repeat finding.
Recommendation:
We recommend that further processes and training be put in place to ensure that the sliding fee scale is
accurately applied to all qualifying program participants and applicable documentation is retained.
Views of responsible officials:
LifeLong concurs with the finding. LifeLong is working on retraining staff involved in Sliding Fee Discount
Program (SFDP) and training all new staff at new hire orientations. In the future, LifeLong will perform
periodic audits of sliding fee transactions.