Finding Text
FINDING 2024-002 – SPECIAL TESTS AND PROVISIONS Identification of Federal Program U.S. Department of Health and Human Services 93.224 / 93.527 – Health Center Cluster MATERIAL WEAKNESS Criteria – Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients’ ability to pay and their eligibility. A patient’s eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5), 56.108(b)(5), and 56.303(f). The Organization should be implementing and monitoring procedures to properly determine, calculate, and review sliding fee discounts to patients in accordance with the Organization’s sliding fee scale.Condition – While performing our audit, we noted that the Organization did not properly determine the sliding fee discount given to patients selected for testing based on the sliding fee scale in effect for the year ended April 30, 2024. Cause – Policies and procedures were not followed to ensure that the appropriate sliding fee discount adjustment was properly applied to all eligible transactions. Effect or Potential Effect – The Organization did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended April 30, 2024. In addition, the Organization may not have properly calculated the sliding fee discount given to the patients, and the discount given, if any, may not have been based on the patient’s ability to pay. Questioned Costs – None Context – While performing our audit, we noted that the Organization did not have proper documentation to support the sliding fee discount given to 16 out of 40 patients selected for testing based on the sliding fee scale in effect for the year ended April 30, 2024. Repeat Findings – Yes Recommendation – We recommend that the Organization continue to train and develop new personnel on specific processes related to compliance requirements. In addition, the Organization should establish a review process to ensure that sliding scale charges are monitored and reviewed by a supervisor on a periodic basis to ensure compliance. Views of Responsible Officials See accompanying Corrective Action Plan