Finding 1186637 (2025-001)

Item 2025-001 - 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 H80CS00646-23-07, 2 H80CS00646-24-01, 1 H8LCS51923-01-00 for 2024 and 2025, 1 H8NCS54043-01-00 for 2025 - (Significant Deficiency) 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. Waimanalo Health Center'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 the Center did not properly determine the sliding fee discount for one eligible patient, based on information provided during the patient registration process. Cause: Improper determination and application of sliding fee discount based on the Center's eligibility criteria. Effect or Potential Effect: Failure to properly apply the sliding fee discount resulted in a patient being charged incorrectly. Questioned costs: None. Context: One out of sixty samples tested was incorrectly slid. Identification as a repeat finding: This is a repeat of prior year's finding (Finding 2024-004). Recommendation: We recommend that the Center provide training to all personnel involved in determining patients’ sliding fee discounts. In addition, we recommend that an internal audit of a sample of patient charts be conducted periodically to verify that sliding fee scale discounts or categories are properly and accurately determined based on the information provided by patients. Finally, we recommend that the results of such internal audits be formally documented. Management response: Management agrees with the finding and will be establishing policies and procedures and conducting training for all personnel involved in determining patients' sliding fee discounts to help ensure the accuracy of the process. Management will also implement an internal audit of a sample of patient charts and will ensure that such audits are properly documented.