Finding 1228389 (2025-001)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2025
Accepted
2026-08-31

AI Summary

  • Core Issue: The sliding fee discount schedule was incorrectly configured in the billing system, leading to improper discount calculations for eligible patients.
  • Impacted Requirements: The Center failed to comply with Health Center Program requirements, as discounts were not applied according to the Board-approved schedule.
  • Recommended Follow-Up: Implement stronger internal controls, including a review process for schedule changes and regular checks to ensure discounts align with the approved schedule.

Finding Text

Finding No. 2025-001: Special Tests and Provisions (Sliding Fee Discounts) Federal Awarding Agency: U.S. Department of Health and Human Services Federal Program Title: Health Center Program Cluster Awards: ALN 93.224 Consolidated Health Centers Criteria: Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. A patient's ability to pay is determined on the basis of the Federal Poverty Guidelines, as revised by the Department of Health and Human Services (DHHS). Condition: The Center’s Board-approved sliding fee discount schedule was not configured correctly within the eClinicalWorks (eCW) billing system. As a result, patient sliding fee discounts were calculated using an incorrect schedule, and discounts were not applied in accordance with the Center’s approved policy. Cause: The Center did not have adequate internal controls in place to ensure that the approved sliding fee discount schedule was accurately entered and maintained in the billing system, or that discounts generated by the system were reconciled to the approved schedule. Effect: Because the sliding fee discount schedule was misconfigured at the system level, the exceptions are not limited to the transactions selected for testing — the incorrect schedule had the potential to affect all patient encounters to which a sliding fee discount was applied during the year. The Center was therefore unable to demonstrate that sliding fee discounts were determined in accordance with the Health Center Program requirements and its Board-approved schedule, and the total financial effect on patient discounts could not be quantified. Questioned Costs: None. The noncompliance relates to the calculation of patient sliding fee discounts and did not result in costs charged to the federal award that are questioned; however, as noted above, the effect on patient discounts could not be quantified. Context/Sampling: A statistically valid sample of 40 sliding fee discount transactions was tested to determine whether discounts were calculated in accordance with the Organization's approved sliding fee discount schedule. Testing identified 5 instances (12.5%) in which the sliding fee discount was calculated incorrectly. Repeat Finding: No Recommendation: The Organization should establish internal controls to ensure the Board-approved sliding fee discount schedule is accurately entered and maintained in the eCW billing system, including a secondary review of any changes to the schedule and a periodic reconciliation of system-generated discounts to the approved schedule. View of Responsible Officials and Planned Corrective Action: Management agreed with the audit finding and has strengthened internal controls and accountability to correct the deficiency.

Corrective Action Plan

Finding 2025-001 — Special Tests and Provisions – Sliding Fee Discount Program Federal Program: Health Center Program Cluster, ALN 93.224 Federal Agency: U.S. Department of Health and Human Services (Health Resources and Services Administration) Condition (as reported): The Organization’s Board-approved sliding fee discount schedule was not configured correctly within the eClinicalWorks (eCW) billing system, resulting in patient sliding fee discounts that were not calculated in accordance with the Organization’s approved schedule. Name of Contact Person Responsible for Corrective Action: Hope Beemer, Chief Financial Officer 513.318.1188 | hope.beemer@centerpointhealth.org Corrective Action Taken: The Organization has corrected the condition identified in the finding. Specifically: • In 2025, Centerpoint Health utilized an outside vendor for billing services. To strengthen internal oversight and accountability, billing was brought in-house in January 2026 with the hiring of a Director of Revenue Cycle Management. By April 2026, all billing and revenue cycle operations were fully transitioned to Centerpoint Health’s internal team. • The Board of Directors reviewed and approved an updated sliding fee discount schedule in May 2026, which was implemented in the eClinicalWorks (eCW) billing system with an effective date of February 1, 2026. • Prior to implementation, management verified that the approved schedule was accurately configured in eCW by comparing system-generated discounts to the Board-approved schedule across each discount tier. • Patient encounters affected during 2025 were reviewed and discounts are adjusted where necessary. This was completed by August 2026. Ongoing Controls to Prevent Recurrence: • Any change to the sliding fee discount schedule in eCW requires a secondary, independent review and approval before the change is activated. • Management performs a quarterly reconciliation of system-generated sliding fee discounts to the current Board-approved schedule and investigates and resolves any exceptions. • The sliding fee discount schedule is reviewed and approved by the Board of Directors at least annually and is updated for changes in the Federal Poverty Guidelines. • Billing and front-desk staff receive annual training on the sliding fee discount policy and schedule. Anticipated Completion Date: • Completed. The updated Board-approved sliding fee discount schedule was implemented effective February 1, 2026, and the ongoing monitoring controls described above are in effect.

Categories

Special Tests & Provisions Internal Control / Segregation of Duties

Programs in Audit

ALN Program Name Expenditures
93.224 HEALTH CENTER PROGRAM (COMMUNITY HEALTH CENTERS, MIGRANT HEALTH CENTERS, HEALTH CARE FOR THE HOMELESS, AND PUBLIC HOUSING PRIMARY CARE) $2.48M
59.008 DISASTER ASSISTANCE LOANS $141,277
93.217 FAMILY PLANNING SERVICES $80,998