Finding 1155368 (2025-001)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2025
Accepted
2025-09-25
Audit: 367610
Organization: Milwaukee Health Services, Inc. (WI)
Auditor: Wipfli LLP

AI Summary

  • Core Issue: Two out of 40 sliding fee transactions were incorrectly calculated, leading to potential overcharging or undercharging of patients.
  • Impacted Requirements: Milwaukee Health Services, Inc. failed to follow its own policies for documenting and calculating sliding fees based on patients' income levels.
  • Recommended Follow-Up: Review and enhance policies and controls to ensure compliance with the sliding fee policy and accurate fee determination.

Finding Text

Finding 2025-001: Special Tests and Provisions - Sliding Fees Program Title: Health Center Cluster Assistance Listing Number: 93.224 Federal Award Year: February 1, 2024 to January 31, 2025 Federal Agency: U.S. Department of Health and Human Services Criteria Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition Wipfli LLP tested 40 sliding fee transactions to verify if the amount charged was calculated properly based on the patient's income level and in compliance with Milwaukee Health Services, Inc.’s sliding fee policy. Wipfli LLP noted that two (2) of the sampled transactions were not properly determined resulting in the patients being improperly over or undercharged for services. Questioned Costs Undetermined. Cause and Effect Milwaukee Health Services, Inc. did not properly follow its policies for documenting and calculating charges for services when using the sliding fee scale. Patients may be charged the improper amount if proper procedures and controls are not in place to ensure the sliding fee is applied in accordance with Milwaukee Health Services, Inc.’s sliding fee policy. Auditor’s Recommendation Review policies and implement and monitor controls surrounding the determination of the fees charged to patients to determine that fees are being determined in accordance with Milwaukee Health Services, Inc.'s sliding fee policy. View of Responsible Officials Management agrees with the findings and has committed to a corrective action plan

Corrective Action Plan

Milwaukee Health Services, Inc. (the "Organization") submits the following corrective action plan for the identified finding and questioned costs for the year ending January 31, 2025. Finding 2025-001: Special Tests and Provisions - Sliding Fees Statement of Condition: External auditors reviewed 40 sliding fee transactions to verify if the amount charged under the Organization's sliding fee program was calculated properly based on the patient's income level and in compliance with the Organization's sliding fee policy. External auditors noted that two ofthe sampled transactions were not properly determined resulting in the patients being over or undercharged for services. Corrective Action: The Organization will review its sliding fee policies and monitor determinations. Staff responsible for sliding fee determinations will be trained on properly computing sliding fees. The Organization will also review the system controls and safeguards within OCHIN Epic (Electronic Health Record) for assisting in sliding fee calculation accuracy. Person Responsible for Corrective Action: Joyce Nwatuobi, Chief Financial Officer Anticipated Timing for Completion of Corrective Action: November 30, 2025.

Categories

Special Tests & Provisions

Programs in Audit

ALN Program Name Expenditures
93.224 Health Center Program (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $2.69M
93.918 Grants to Provide Outpatient Early Intervention Services with Respect to Hiv Disease $479,466
93.493 Congressional Directives $450,828
93.526 Grants for Capital Development in Health Centers $302,679
93.527 Grants for New and Expanded Services Under the Health Center Program $36,446
21.027 Coronavirus State and Local Fiscal Recovery Funds $28,520
93.917 Hiv Care Formula Grants $7,284
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $3,532