Finding Text
Criteria: Under this selected program, eligible individuals receive a sliding fee discount on amounts owed for health center services based on family size and income levels in comparison to the federal poverty guidelines. The Organization should maintain records providing evidence that the patients included under this program are eligible.
Condition: During the compliance testing of 40 sample items, there was one instance where the Organization applied a sliding fee discount to a patient who had not submitted any documents regarding their income level or family size and should not have been included as a sliding fee patient, and two instances where the patients had properly submitted their forms, but the Organization applied the incorrect sliding fee rate.
Effect: Currently, there is no known monetary impact, improper expenditure of funds or questioned costs identified. However, if the Organization does not strengthen the internal controls in regard to the eligibility determination process, there is a possible effect on the ability of the Organization to obtain additional funding under this program if ineligible patients are being treated with grant funding.
Cause: There is a lack of review in regard to obtaining, retaining and approving documentation that support individual's eligibility for the program.
Recommendation: We recommend that the Organization review policies, procedures and practices in place over the controls related to obtaining, retaining and reviewing proof of income support for patients.
Repeat Finding?: Yes, this is a repeat finding of 2023-002.
Views of responsible officials and planned corrective actions: See attached letter.
Reportable questioned costs: None