Finding Text
2022-001 Lack of Support for Allowable Cost/Cost Principles Requirement U.S. Department of Health and Human Services Health Center Cluster (93.224 and 93.527) Federal Award Year 2021-2022 Criteria: The Health Center must prepare and apply a sliding fee discount schedule so that the amounts owed for Health Center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay (42 USC 254(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)). Condition: While testing the special tests and provisions requirement, we noted there was one patient for which the Health Center did not have documentation to support whether the sliding scale discount was appropriately provided, one patient where the sliding scale discount was erroneously calculated, and one patient who qualified for the sliding scale discount that was erroneously not provided a sliding scale discount. Cause: The Health Center did not have consistent controls for application of the sliding fee discounts. Documentation to support the usage of the sliding fee discount was not consistently maintained, and in instances where documentation was maintained, the sliding fee discounts were not calculated appropriately based on the information provided by the patient. Effect: Sliding scale adjustments totaling $4 were provided in error to one patient. Sliding scale adjustments totaling $187 were not provided to two patients that qualified for the sliding scale adjustments. Questioned Costs: $183 Context: We noted sliding scale adjustments were inappropriately applied to 3 of 60 patients tested. Repeat finding?: 2021-002 Recommendation: We recommend that additional training of responsible staff be performed to ensure that all documentation related to the sliding scale adjustments is retained and that sliding scale adjustments are applied to qualifying patients in the correct amounts. View of responsible officials of the auditee: Management agrees with the finding and recommendation.