Finding Text
Item 2025-002 - 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 H80CS00505-23-04, 6 H2ECS45602-02-04, 1 H8LCS50772-01-00 and 6 H8HCS46163-03-01 - (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. LBUCC’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 LBUCC did not properly determine the sliding fee discount provided to certain eligible patients based on information provided during the patient registration process. Additionally, we could not ascertain if the sliding fee discount provided to certain eligible patients were correct as LBUCC did not maintain documentation of the proof of income of those eligible patients. Cause: Lack of proper documentation of eligibility requirements and lack of review process for the determination of sliding fee discount for eligible patients. Effect: Failure to properly apply the sliding fee discount resulted in certain patients being charged incorrect amounts. Questioned Costs: None Context: Out of sixty samples tested, one sample’s family income was incorrectly encoded to the system which resulted in the patient being improperly slid and nine patients had no proof of income on file. Identification as a Repeat Finding: This is not a repeat finding. Recommendation: We recommend that LBUCC conduct training of all of its personnel who are involved in determining and applying the sliding fee scale of patients. We also recommend LBUCC to maintain complete and auditable documentation supporting each patient’s eligibility for sliding fee discount. Management Response: Management agrees with the finding and will implement these measures to ensure equitable access to care, maintain compliance with federal program standards and support accurate reporting and reimbursement