Finding Text
Federal Agency: U.S. Department of Health and Human Services (HHS) Federal Program Name: Consolidated Health Centers (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, Public Housing Primary Care, and School Based Health Centers); (HHS Community Health Center Program) Assistance Listing Number: 93.224/93.527 Criteria or Specific Requirement: 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. Condition: During a sample of 40 patient visit encounters, we noted 1 patient vision visit that had the incorrect sliding fee amount applied based on the proof of income provided. In addition, an additional sliding fee error was noted during audit procedures over revenue. Questioned Costs: None Context: The Organization did not properly apply a sliding fee adjustment to 1 of 40 patients tested. In addition, an additional sliding fee error was noted during audit procedures over revenue. Cause: Management was unable to identify a definitive cause for the exception. Follow-up review of 15 additional vision sliding fee calculations within the same category identified no additional errors. As such, the exception appears to have been an isolated processing error that was not detected through existing review procedures. Additionally, revenue test of detail procedures identified a second sliding fee exception in which a patient was incorrectly charged $30 instead of the appropriate $15 balance due to an immunization not receiving the proper sliding fee discount. Effect: Patient was charged $10 instead of the required $15 flat fee under Sliding Fee B and a patient was charged $30 for an immunization verses the appropriate fee of $15 with their slide. Repeat Finding: Yes Recommendation: We recommend management continue to strengthen review controls over the setup, maintenance, and application of sliding fee discount schedules, including periodic monitoring procedures to identify and promptly correct exceptions. Views of Responsible Officials: Management reviewed 15 additional vision sliding fee calculations within the same category and determined all were calculated correctly. Management was unable to identify a systemic issue or recurring error and believes the exception was isolated in nature. Corrective Action Plan: Management has established a system of review and documentation of an internal audit that is conducted monthly to ensure slides are being applied properly.