Finding 1175686 (2025-004)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2025
Accepted
2026-02-27

AI Summary

  • Core Issue: Family size discrepancies were found between sliding fee applications and billing software for 8 out of 40 patients.
  • Impacted Requirements: Incorrect income calculations due to wrong pay frequency affected eligibility for 2 out of 40 patients.
  • Recommended Follow-Up: Update sliding fee applications based on patient inquiries and ensure accurate income calculations to align with documentation.

Finding Text

For 8 of the 40 patients tested, the documented family size on the sliding fee discount application did not match the family size recorded in the billing/registration software used to calculate the patient's sliding fee discount level. These family size differences were a result of additional patient inquiries clarifying the proper family size, but the sliding fee application was not subsequently updated. Also, for 2 of the 40 patients tested, the income used to determine sliding fee discount eligibilty was calculated using an incorrect pay frequency. As a result, the annualized income recorded in the sliding fee determination did not agree with the income documentation provided, and in some cases placed patients in the wrong discount pay class.

Corrective Action Plan

Management has currently implemented procedures to have sliding fee application information reconciled to the applicable information in the billing system.

Categories

No categories assigned yet.

Other Findings in this Audit

  • 1175684 2025-002
    Material Weakness Repeat
  • 1175685 2025-003
    Material Weakness Repeat

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) $3.97M