Finding 1223793 (2026-101)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2026
Accepted
2026-07-16

AI Summary

  • Core Issue: One out of forty sliding fee scale discount forms had an incorrect discount, raising concerns about accuracy in patient discounts.
  • Impacted Requirements: Proper documentation and calculation of patient income levels are essential as per 42 CFR Section 51c.303(f).
  • Recommended Follow-Up: Conduct random reviews of sliding fee scale applications to identify and correct errors promptly.

Finding Text

2026-101 Special Tests and Provisions - Sliding Fee Scale Discounts Federal program: Health Center Program Cluster / FAL 93.224 Health Center Program U.S. Department of Health and Human Services Federal grant number H80CS00416 Questioned costs: not applicable Criteria: Patients applying for sliding fee scale (SFS) discounts should have their income levels adequately documented and accurately calculated, and patients should be given the proper discount based upon their income level in accordance with 42 CFR Section 51c.303(f). Condition: The Center requires patients that apply for the SFS discount to complete attestation forms that includes their household sizes and income levels, and these forms are then used to determine patients' SFS discounts. One patient attestation form out of forty SFS patient encounters that we tested reflected an incorrect SFS discount. Cause: Unknown Effect: Due to incorrect attestation forms, we could not determine whether the Center consistently provided patients with the proper discount based upon their income levels. Recommendation: To help ensure that SFS discounts are properly calculated and documented, the Center should perform random reviews of its SFS applications in order to detect and correct errors or incomplete applications on a timely basis.

Corrective Action Plan

Recommendation: To help ensure that sliding fee scale (SFS) discounts are properly calculated and documented, the Center should perform random reviews of its SFS applications to detect and correct errors or incomplete applications on a timely basis. Corrective Action Taken: 1. Immediate Review and Correction Upon determination of the finding, we conducted a full review of the affected patient account. 2. Staff Training All Outreach and Eligibility staff have received refresher training on the proper application of the sliding fee scale, including income verification processes and documentation standards. This training now occurs as part of onboarding and annually thereafter. 3. Policy and Procedure Review We reviewed our internal policies and procedures to ensure clear guidance on income documentation requirements, allowable income sources, and how to properly apply the sliding scale. 4. Double-Verification Process A second-level review has been instituted for all new patient applications and renewals involving sliding fee scale determinations. This ensures that income is correctly assessed, and the appropriate fee level is applied before any charges are finalized. 5. Audit and Monitoring A quarterly internal audit process has been implemented to review a random sample of sliding fee scale determinations for accuracy. Findings from these audits will be tracked, and any trends will be addressed through targeted training or process changes. The corrective actions implemented in the prior year were maintained consistently throughout the current audit period. Based on our evaluation, the processes put in place were operating effectively as designed. The issue identified this year stemmed from front office personnel having access to modify SFS assignments after they had already been appropriately verified and assigned. This access created the opportunity for adjustments outside of the established control process. While the prior corrective actions were effective, we have identified the need for an additional control enhancement. Accordingly, an immediate control has been implemented (see item 6 below) to further restrict access and prevent unauthorized modifications. 6. EMR Restriction As a result of the additional finding identified in 2026, UCHC’s IT Department access to SFS assignments and modifications within the EHR will be restricted exclusively to the Eligibility Team. No other personnel will be permitted to make changes to SFS assignments. All requests for adjustments must be submitted to the Eligibility Team, which will be responsible for thoroughly reviewing and validating each request prior to implementing any changes.

Categories

Special Tests & Provisions

Other Findings in this Audit

  • 1223794 2026-102
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.224 HEALTH CENTER PROGRAM $2.74M
93.526 GRANTS FOR CAPITAL DEVELOPMENT IN HEALTH CENTERS $527,593