Finding 1174049 (2024-003)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2026-02-17

AI Summary

  • Core Issue: Patients received incorrect sliding fee discounts due to non-compliance with the Organization's policy.
  • Impacted Requirements: Failure to update the sliding fee scale annually as per federal guidelines.
  • Recommended Follow-Up: Ensure staff are trained on the sliding fee policy and implement procedures for accurate discount application and timely updates.

Finding Text

Health Center Program Cluster Assistance Listing 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 2 H80CS26560-11-00 Program Year 2024 Criteria or Specific Requirement: Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g); and 42 CFR sections 56.303 (f)) Condition: Patients received a sliding fee discount that was inconsistent with the documented sliding fee discount categories under the Organization's Policy. In addition, the Organization did not update the sliding fee scale for annual changes to the poverty guidelines timely. Cause: The Organization did not comply with its sliding fee policy. Effect or Potenital Effect: Incorrect sliding fee discounts were given. Questioned Costs: None Context: A sample of 40 patients was tested out of the total population of 1,420 encounters and 12 errors were noted where patients received an incorrect sliding fee adjustment. The sampling methodology used is not and is not intended to be statistically valid. Identification as a Repeat Finding: Repeat Finding of 2023-003 Recommendation: We recommend that management continue to ensure that all personnel understand the sliding fee scale policy and adhere to the requirements and guidelines set forth in the policy. Procedures should be implemented to ensure that eligible patients receive discounts in accordance with the sliding fee scale and the Health Center Program Compliance Manual. In addition, management should ensure the Organization's sliding fee scale is updated annually in accordance with federal guidelines.

Corrective Action Plan

Views of Responsible Officials and Planned Corrective Action: A new Sliding Fee Discount Policy was approved by the Board of Directors in March 2025. It was published and staff were trained at all sites. Identified inconsistencies will result in additional training for the staff involved. The Sliding Fee Discount Schedule is on the board schedule to be review annually in conjunction with the updated federal poverty guidelines. There has been a workflow developed for distributing this information once the new Sliding Fee Discount Schedule is approved by the board of directors.

Categories

Special Tests & Provisions

Other Findings in this Audit

  • 1174046 2024-003
    Material Weakness Repeat
  • 1174047 2024-003
    Material Weakness Repeat
  • 1174048 2024-003
    Material Weakness Repeat
  • 1174050 2024-004
    Material Weakness Repeat
  • 1174051 2024-004
    Material Weakness Repeat
  • 1174052 2024-004
    Material Weakness Repeat
  • 1174053 2024-004
    Material Weakness Repeat
  • 1174054 2024-005
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
21.027 CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY FUNDS $240,000
93.224 HEALTH CENTER PROGRAM (COMMUNITY HEALTH CENTERS, MIGRANT HEALTH CENTERS, HEALTH CARE FOR THE HOMELESS, AND PUBLIC HOUSING PRIMARY CARE) $200,000
93.527 GRANTS FOR NEW AND EXPANDED SERVICES UNDER THE HEALTH CENTER PROGRAM $189,062
93.778 MEDICAL ASSISTANCE PROGRAM $48,873
93.332 COOPERATIVE AGREEMENT TO SUPPORT NAVIGATORS IN FEDERALLY-FACILITATED EXCHANGES $19,806