Finding 366682 (2023-001)

2023-001 – Material weakness related to sliding fee scale discount application. Federal agency – United States Department of Health and Human Services Federal program - Health Centers Cluster - Affordable Care Act Grants for New and Expanded Services under the Health Center Program Assistance Listing # – 93.527 Grant ID # - L2CCS42380 Grant award period – FY 2022-2023 Compliance requirement – special tests and provisions Criteria – Management is responsible for establishing and maintaining effective internal controls over determining sliding fee discounts and write-offs. Federal grant funds received by the Center required that the Center maintain a sliding fee write-off policy based on income and family size thresholds. Condition – The auditor noted during its testing of sliding fee discounts that eleven out of forty sliding fee discounts were incorrectly calculated and/or applied. Questioned costs - $-0- Context – Grant specific requirements direct the grant recipient to comply with policies surrounding sliding fee discounts. Effect – This condition creates a risk that patients can be under or over charged for services provided by the Center, which is not in compliance with the Center’s federal grant guidelines. Cause – The cause of this deficiency is related to human input error and incorrect or outdated system information. In some cases, the sliding fee discount was assessed with information already in the electronic health system that did not match current patient income and family threshold attestations. Of the eleven sliding fee discounts that were incorrectly calculated and/or applied, three patients were assessed at a lower level of fee assistance and were over charged a sliding fee discount, two patients were assessed at a higher level of fee assistance and were under charged a sliding fee discount, and six patients were under charged and received a sliding fee discount that should have paid full charge based on not meeting fee assistance thresholds. Recommendation – The auditor recommends that procedures and policies surrounding sliding fee discounts are reviewed and revised in order to strengthen internal controls to help ensure calculations and applications of sliding fee discounts are done correctly. In addition, the auditor recommends that all system settings surrounding sliding fee discounts are reviewed to make sure calculations are correctly performed. Views of Responsible Officials and Planned Corrective Action - Management concurs with audit finding 2023-001. The Center is developing procedures and policies surrounding review of sliding fee discounts are reviewed and revised in order to strengthen internal controls to help ensure calculations and applications are done correctly.