Finding 1228458 (2024-008)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2026-08-31
Audit: 410112
Organization: Sayre Health Center (PA)
Auditor: CBIZ CPAS PC

AI Summary

  • Core Issue: The Health Center failed to document the sliding fee discount application based on patient eligibility.
  • Impacted Requirements: Inadequate controls and staff turnover led to improper discounts and potential mismanagement.
  • Recommended Follow-Up: Implement procedures for proper discount application and formal documentation of eligibility reviews.

Finding Text

U.S. Department of Health and Human Services: Health Center Program and American Rescue Plan Act Funding for Health Centers, ALN 93.224; Ending HIV Epidemic – Primary Care HIV Prevention, ALN 93.527. Criteria The Health Center is required to apply a sliding fee discount for health services provided to eligible patients. This sliding fee discount is based on the patient’s ability to pay. Condition and Context The Health Center was unable to provide documentation to support the service provided and income requirements of patients and the proper application of the sliding fee discount to patients seen during the year. Cause Staff turnover in the Finance Department coupled with inadequate controls to ensure that the sliding fee discount was properly applied to patient’s based on their eligibility. Effect and Potential Effect Discounts to patient service fees may have been improperly provided and inaccurate information may have been used in making management decisions during the year. Questioned Costs Amount, if any, could not be determined due to lack of supporting documentation. Repeat Finding Yes (2023-008). Recommendation We recommend that management implement procedures to ensure that the sliding fee discount is properly applied to patients based on their eligibility. We also recommend that management implement a process of formal documenting the review and approval of sliding fee discount eligibility forms. Such forms should also be retained in case needed for future reference purposes. Views of Responsible Officials and Planned Corrective Action See corrective action plan.

Corrective Action Plan

Finding No. 2024-008: Inadequate Documentation and Records for Application of Sliding Fee Discounts We have incorporated a policy that establishes the basis for the sliding fee policy to assure affordable access to care for uninsured and underinsured patients of the organization. The policy will recognize a “full discount” for individuals and families with annual incomes at or below 100% FPL with only nominal fees charged, three levels of discount between 100% and 200%, and no discounts for copays for individuals and families earning over 200% FPL. This policy will be in accordance with Section 330(k)(3)(G) of the PHS Act and 42 CFR Part 51c.303(f) and 42 CFR Part 51c.303(u) which are incorporated herewith. We will charge a nominal fee to individuals and families with annual incomes at or below 100% of the Federal poverty level (FPL). Patients whose incomes are above 100% and at or below 200% of the FPL will be charged according to our sliding fee scale based on income and family size. Discounts will be provided to patients with incomes up to 200% of the FPL for medical visits. Discounts will be provided to patients with incomes up to 250% of the FPL for family planning visits. Staff will assess patients’ incomes based upon a sliding fee scale and no patient will be denied care based upon their inability to pay. The organization also has a policy of non-discrimination in the delivery of health care as stated in its Patient Bill of Rights. Also, the Board of Directors define the income and family size, and has defined the family size to be all parents, minors or guardians that are financially responsible for the household. The tracking and documentation of sliding fees is now maintained with the deposit record of each fee received in the shared file for immediate availability and reference.

Categories

Subrecipient Monitoring Eligibility

Other Findings in this Audit

  • 1228438 2024-006
    Material Weakness Repeat
  • 1228439 2024-007
    Material Weakness Repeat
  • 1228440 2024-008
    Material Weakness Repeat
  • 1228441 2024-009
    Material Weakness Repeat
  • 1228442 2024-010
    Material Weakness Repeat
  • 1228443 2024-011
    Material Weakness Repeat
  • 1228444 2024-006
    Material Weakness Repeat
  • 1228445 2024-007
    Material Weakness Repeat
  • 1228446 2024-008
    Material Weakness Repeat
  • 1228447 2024-009
    Material Weakness Repeat
  • 1228448 2024-010
    Material Weakness Repeat
  • 1228449 2024-011
    Material Weakness Repeat
  • 1228450 2024-006
    Material Weakness Repeat
  • 1228451 2024-007
    Material Weakness Repeat
  • 1228452 2024-008
    Material Weakness Repeat
  • 1228453 2024-009
    Material Weakness Repeat
  • 1228454 2024-010
    Material Weakness Repeat
  • 1228455 2024-011
    Material Weakness Repeat
  • 1228456 2024-006
    Material Weakness Repeat
  • 1228457 2024-007
    Material Weakness Repeat
  • 1228459 2024-009
    Material Weakness Repeat
  • 1228460 2024-010
    Material Weakness Repeat
  • 1228461 2024-011
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.224 HEALTH CENTER PROGRAM $1.34M
93.527 GRANTS FOR NEW AND EXPANDED SERVICES UNDER THE HEALTH CENTER PROGRAM $2,616