Finding Text
Item 2024-004 - Special Tests and Provisions - U.S. Department of Health and Human Services, Health Center Program Cluster (Assistance Listing Number 93.224/93.527) Notice of Award Number 6 H80CS00646-22-03, 2 H80CS005646-23-00, 4 H8GCS48213-01-01, 1 H8LCS51923-01-00 for 2023 and 2024 - (Material Weakness)
Criteria:
US Code Title 42, The Public Health and Welfare Act, Section 254b requires health centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Waimanalo Health Center's policy requires that sliding fee discount be modified on an annual basis based on the federal poverty level after the board's approval.
Statement of condition:
During our audit, we noted that the Center did not properly determine the sliding fee discount of certain eligible patients based on information provided during the patient registration process.
Cause:
Improper determination and application of sliding fee discount based on the Center's eligibility criteria.
Effect:
Failure to properly apply the sliding fee discount resulted in certain patients being charged incorrect amounts.
Questioned costs:
None
Context:
1 sample patient with 4 sample visits was incorrectly slid.
Identification as a repeat finding:
This is not a repeat finding.
Recommendation:
We recommend that the Center conduct training of all of its personnel who are involved in determining the sliding fee scale of patients. We also recommend that an internal audit of a sample of patient charts be conducted periodically to ensure that patients' sliding fee scale discounts or category is properly and accurately determined based on information provided by patients. Finally, we recommend that such internal audit be documented.
Management response:
Management agrees with the finding and will be establishing policies and procedures and conducting training for all personnel involved in determining patients' sliding fee scale to help ensure the accuracy of the process. Management will also implement an internal audit of a sample of patient charts and will ensure that such audits are properly documented.