Finding Text
Federal Agency: U.S. Department of Health and Human Services Federal Program: Consolidated Health Centers Grant AL Number: 93.224 & 93.527 Award Period: 4/1/25 - 3/31/26 Type of Finding: Material Weakness in Internal Control Over Compliance and Compliance Criteria or Specific Requirement Per Title 42 Chapter 1 Subchapter D Section 51c303(f), “Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay.” Condition and Context During our testing of 60 sliding fee discounts for health center patients qualifying for reduced charge visits, we identified two visits where an incorrect sliding fee was given to a patient based on their income and family size. Effect Potential that a patient would not receive the appropriate sliding fee discount. Questioned Costs None identified. Cause The sliding fee discount error was a result of a dental electronic medical record conversion in fiscal year 2025. During quarter three of fiscal year 2025, the Organization’s staff identified an issue within the dental electronic medical record where it was populating the incorrect federal poverty level for patients based on the income level and family size input by the Organization’s staff. This caused the incorrect sliding fee adjustment to be applied to patient balances. Recommendation We recommend the Organization to review internal controls in regards to the determination, recording, and monitoring of the sliding fee process to ensure that appropriate sliding fee rates/categories are utilized for each sliding fee encounter. Views of Responsible Officials Management is aware of this issue and meets regularly to discuss the workflows identified to minimize this issue until the vendor has implemented an interface to resolve this issue. The Organization has procedures in place to address the internal controls related to determining, recording, and monitoring the sliding fee process. The goal is to ensure that the appropriate sliding fee rates/categories are utilized for each encounter for each patient. The Organization has been working with the electronic health record vendor to interface the medical and dental components of the system to ensure the information is flowing across both components of the application. The sliding fee scale information is housed in the medical component of the system and does not consistently flow to the dental component of the system. The tentative go live date for this interface is scheduled for September 2026. Until then the team will continue to assess all dental sliding fee scale patients accounts manually to ensure accurate sliding fee rates/categories are utilized for each sliding fee encounter/patient.