Finding Text
Federal Agency: Department of Health and Human Services Federal Program: 93.224 Health Center Program Identification Numbers: H80CS29007 H8DCS36329 H8ECS38904 H8FCS41132-01-00 Requirement: Special Tests and Provisions Type of Finding: Significant deficiency in internal control over major program; Noncompliance Criteria: Patient charges are adjusted based on income and family size by applying the Health Center’s sliding fee discount schedule. Condition: Sliding fee discounts are not applied appropriately for all patients. Cause: There is no management oversight in this area. Also, employees have not been properly trained and are not consistently utilizing the software that maintains patient data. Effect: The Health Center is not compliant with federal regulations which could result in the federal government imposing additional requirements or withholding, disallowing or suspending grant funds. Context: Out of the 60 patients selected for testing, 11 were charged less than they should have been, 4 patients were charged more than they should have been and 1 patient was unable to be tested due to a lack of documentation. The Health Center’s sliding fee policy calculates fees based on gross monthly pay. For 2 patients selected for testing, the calculation was based on their monthly net pay. Repeat Finding: This finding was reported for the years ended June 30, 2022 and 2021 as 2022-004 and 2021-006, respectively. Recommendation: All elements required for the sliding fee discount should be properly maintained in Allscripts, including documentation of zero household income. Employees should be properly trained on the software, and a user manual should be created related to patient intake so patient records are consistent and documented appropriately. The sliding fee discount noted in the patient data software should correspond to the co-pay amount listed on patient billings. Health Center staff in charge of billing should review the patient data to ensure the correct adjustment was made and patients were charged the correct co-pay amount. Any discrepancies should be brought to the attention of Health Center management before bills are processed. Views of Responsible Official(s) and Planned Corrective Actions: See corrective action plan.