Finding 1208848 (2025-001)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2025
Accepted
2026-04-27
Audit: 399803
Auditor: CHW LLP

AI Summary

  • Core Issue: The Center did not consistently apply its sliding fee policy, leading to potential miscalculations in patient discounts.
  • Impacted Requirements: Compliance with federal grant provisions for patient eligibility and sliding fee adjustments was not fully met.
  • Recommended Follow-Up: Provide employee training on sliding fee requirements and conduct regular audits to ensure compliance.

Finding Text

N Special Tests and Provisions ALN: 93.224 Program: Community Health Center Cluster Agency: US Department of Health and Human Services Compliance Requirement: N- Special Tests and Provisions Repeat Finding: No Criteria: Federal grant compliance provisions require that the Center correctly identify a patient's ability to pay and that the rates for services be adjusted accordingly based on the sliding fee schedule. Center is required to follow its sliding fee policy when providing discounts to eligible patients. Condition: In our sample of 40 tested items, for two selections patient information was not in accordance with policy to correctly determine the proper sliding fee discount and/or the patient eligibility, and for one selection the sliding fee application expired. Questioned Cost: None. Effect: Lack of strict enforcement of the policy of sliding fee eligibility determination and compliance may have resulted in Center providing discounted services greater to or less than the appropriate amounts to beneficiaries. Cause: Inadequate retention of the sliding fee program documentation requirements and Center policies by employees involved in sliding fee process. Recommendation: Training should be provided to employees on the sliding fee program requirements. Center should perform regular audits of sliding fee transactions to identify weaknesses in compliance. Views of Responsible Officials and Corrective Action Plan: Center agrees with the finding and will implement additional controls to ensure that this does not recur. Please refer to the corrective action plan.

Corrective Action Plan

Corrective Action: The Center will: - Provide immediate re-training to staff on issues identified, and - Continue to provide ongoing training to current and new staff involved in Sliding Fee Discount Program (SFDP) on program requirements and proper implementation of sliding fee determination and billing, and - Have updated procedures for the Sliding Fee Discount Program approval process in which all sliding fee required documents are reviewed and approved by a Clinic Manager or his/her designee for program compliance within 3-5 business days. Revise SFDP application form to add the space where Clinic Manager or designee can document the reviewed by and date of approval, and - Continue ongoing SFDP Chart Audits to assess compliance with policy and guidelines, staff knowledge, and provide feedback, as needed.

Categories

Special Tests & Provisions Eligibility

Programs in Audit

ALN Program Name Expenditures
93.224 CONSOLIDATED HEALTH CENTERS (COMMUNITY HEALTH CENTERS, MIGRANT HEALTH CENTERS, HEALTH CARE FOR THE HOMELESS, AND PUBLIC HOUSING PRIMARY CARE) $5.66M
10.561 STATE ADMINISTRATIVE MATCHING GRANTS FOR THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM $424,511
93.217 FAMILY PLANNING_SERVICES $121,177
93.526 AFFORDABLE CARE ACT (ACA) GRANTS FOR CAPITAL DEVELOPMENT IN HEALTH CENTERS $34,543