Finding 1130419 (2024-004)

Department of Health and Human Services Federal Financial Assistance Listing #93.224 and #93.527 Community Health Center Cluster Special Tests and Provisions Material Weakness in Internal Control Over Compliance and Noncompliance Criteria Health centers must prepare and apply a sliding fee discount schedule (sliding fee discounts) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The sliding fee discount is based on an individual’s or family’s income in relation to the Federal Poverty Guideline (FPG). In order to support a patient’s eligibility to receive a sliding fee discount, the health center is required to obtain certain documentation from the patient and/or family to support the patient’s or family’s income in relation to the FPG. Condition The Organization failed to obtain the required income verification from three patients; however, these patients were given the sliding fee discount. Cause Internal controls in place did not ensure that the sliding fee discount was not given until all income verification was obtained. Or in cases where the sliding fee discount was granted pending income verification, the income verification was not completed resulting in a sliding fee discount being given without adequate support. Effect The lack of adequate policies governing obtaining the income verification documentation resulted in a sliding fee discount being given without the proper support. In addition, there was not adequate follow up to ensure the income verification was completed for those individuals given the sliding fee discount pending income verification. Questioned Costs Projected to be $25,387. Context A sample size of 65 with a total sample amount of $7,595 was tested. The number of patients who received the sliding fee was 5,512 with a total value or $625,943. Of the 65 tested, four selections, which totaled $556, were given the sliding fee discount when appropriate eligibility documentation was not obtianed. Repeat Finding From Prior Year No Recommendation We recommend that the Organization enhance control policies to obtain the required income verification at the time the sliding fee disounts is granted and to enhance the internal control policies regarding follow up with patients for missing or incomplete income verifications. Views of Responsible Officials Management agrees with the finding.