Finding 374271 (2023-001)

Finding 2023-001: Special Tests and Provisions - Sliding Fee Scale Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster: Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), COVID - 19 - Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), COVID - 19 - Grants for New and Expanded Services under the Health Center Program, Grants for New and Expanded Services under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Criteria Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined based on the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5), 56.108(b)(5) and 56.303(f)). KPHC should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with KPHC's sliding fee scale. Condition KPHC did not always appropriately apply the sliding fee discount based on income levels and family size of patients. Context A test of 40 sliding fee discount transactions was performed and resulted in five instances of sliding fee discounts not being properly calculated based on the respective patient family size and income. Our sample was a statistically valid sample. Questioned Costs None. Cause KPHC did not have adequate internal controls in place to effectively ensure that patients receive the correct sliding fee discount. Effect KPHC did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification of Repeat Finding None. Recommendation KPHC should establish a system of internal controls to ensure that all sliding fee discounts are properly calculated, and patients receive the correct sliding fee discount. Views of Responsible Officials and Planned Corrective Actions Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.