Finding Text
Item 2022-001, Special Tests and Provisions - U.S. Department of Health and Human Services, Health Center Program Cluster (Assistance Listing Number 93.224/93.527/COVID-19 93.224) Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient's ability to pay and their eligibility. A patient's eligibility and ability to pay is determined on the basis of the official poverty guidelines, as revised by HHC (42 CFR Sections 51c. 107(b)(5), 56.108(b)(5) and 56.303(f)). The Center should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Condition: When performing our audit, we noted the Center did not properly determine the sliding fee discount category given to certain patients selected for testing based on sliding fee scale in effect for the year ended May 31, 2022. Cause: There was deficiency in internal controls to ensure that proper documentation was obtained and that proper sliding fee discounts were being applied to patients in accordance with the Center's sliding fee scale. Effect: The Center did not comply consistently with the special tests and provisions compliance requirement based on the poverty guidelines in effect for the fiscal year 2022. In addition, the Center may not have properly calculated the sliding fee discount given to the patients and the discount given, if any, may not have been based on the patient's ability to pay. Questioned costs: None. Context: When performing our audit, we noted that the Center did not properly determine the sliding fee discount given to 3 out of 60 patients selected for testing based on the sliding fee scale in effect for the year ended May 31, 2022. Identification of Repeat Finding: Condition is repeat finding - see 2021-001. Recommendation: We recommend that proper training be given to employees and that sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. We recommend that the Center improve the implementation of their policy regarding keeping and maintaining the patient's proof of income or self-attestation regarding their income. View of Responsible Official: The Center revised its policies and procedures, trained its employees, and restructured the process for the sliding fee program, including strengthening monitoring and hired a new coordinator.