Finding Text
Finding Number: 2025 003 Finding Type: Significant Deficiency in Internal Controls over Compliance related to Special Tests and Provisions and Noncompliance Information on the Federal Program: Program Name: Health Center Program Cluster (93.224) Grant Award: H80CS00802 Budget Period: April 1, 2024 through March 31, 2025 Agency: U.S. Department of Health and Human Services, Health Resources and Services Administration Criteria: In accordance with Section 330(k)(3)(G) of the Public Health Services Act (42 U.S. Code § 254b), as an FQHC, the Organization must have a sliding fee discount program in which patient charges are adjusted based on the patient’s ability to pay. Condition: During testing of a statistically valid sample of 19 patient accounts that received sliding fee discounts, 2 patient files did not contain eligibility documentation to support that the patients qualified for the sliding fee discount at the time the discount was applied. Cause: Controls over the Sliding Fee Discount Program did not consistently ensure that eligibility documentation was obtained and maintained prior to application of discounts. A similar compliance issue was identified in prior year Finding 2024-003; however, corrective actions could not be implemented during the current audit period due to the timing of issuance of the prior year audit report. Effect: Without documented eligibility at the time discounts were applied, the Organization cannot demonstrate that sliding fee discounts were properly supported in accordance with Health Center Program requirements. Questioned Costs: None Repeat Finding: Yes, 2024-003 Recommendation: Management should strengthen controls over the Sliding Fee Discount Program to help ensure eligibility documentation is obtained, documented, and maintained prior to the application of discounted charges. Management should also reinforce procedures for timely completion and retention of eligibility determinations and periodically monitor patient files for completeness. Views of a Responsible Official and Corrective Action Plan: Management agrees with the finding and will implement procedures to ensure sliding fee discount eligibility is documented and maintained prior to application of discounted charges and will strengthen monitoring of eligibility determinations and renewal requirements.