Finding Text
#2024-002: Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing #93.224 and 93.527
Condition: As a result of our audit procedures, we noted an instance where no appropriate supporting documentation or income verification were maintained by Heart of Kansas Family Healthcare, Inc. (the Organization) to substantiate eligibility for the sliding-fee discount the patient received.
Criteria: The sliding-fee scale is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient.
Context: The Organization did not maintain an eligibility application and income verification for 1 out of 40 patients tested.
Cause: The Organization did not ensure that all required documentation, including the sliding fee application and income verification, was obtained and retained in the patient file.
Effect: The absence of required documentation may result in patients receiving sliding fee discounts without proper eligibility verification, potentially leading to noncompliance with program requirements and expose the Organization to reputational risks. Continued noncompliance could result in loss of funding.
Recommendation: We recommend that management reinforce training for all relevant personnel on the sliding fee policy and documentation requirements. Procedures should be strengthened to ensure that all patient files include complete and accurate documentation of eligibility for sliding fee scale adjustments, including the application and income verification. Additionally, a secondary review of the applications and system input could be conducted to ensure proper documentation is verified to support eligibility.
Management Response: See Corrective Action Plan.