Finding 1117516 (2024-003)

Special Provisions Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Health Centers Cluster and Health Center Infrastructure Support Assistance Listing Number: 93.224 and 93.527 Federal Award Identification Number: H80CS00824-22 and H80CS00824-23 Award Periods: May 1, 2023 – April 30, 2024, May 1, 2024 – April 30, 2025 Type of Finding: Immaterial noncompliance and material weakness in internal control over compliance Criteria: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient's ability to pay. (42 USC 254(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)). Condition: The Organization did not assign patients properly to a sliding fee category in their system based on the Organization’s sliding fee scale policy. Information entered into the system did not match the information gathered from patients at the time of the encounter. Questioned Costs: None. Context: Four (4) of forty (40) encounters were not assigned the correct sliding fee category based on the current documentation of family size and income to assess sliding fee discount eligibility. Cause: The information entered into the Organization’s system was not reviewed to verify the proper sliding fee scale was applied for the services performed based on the information gathered from the patient. Effect: Patients may not be assessed a correct sliding fee discount according to the Organization's sliding fee scale and their ability to pay. Repeat Finding: No. Recommendation: We recommend the Organization implement a comprehensive and thorough process to review all patient information received, prior to it being entered into the system to ensure proper classification of the sliding fee scale. As part of this, the Organization should ensure the accuracy and completeness of the patient information prior to entering into the billing software. Management should work to conduct internal audits of patient visits to determine all required patient information has been obtained and properly entered into the system in accordance with the Organization’s sliding fee scale policy.