Finding Text
Finding #: 2022-006 Special Tests and Provisions, Controls over Compliance – Significant Deficiency
Identification of Federal Program and Award
Program title: U.S. Department of Health and Human Services (DHHS): Public Health Services Act, Title III, Section 330 (Health Center Cluster)
CFDA #: 93.224/93.527 Award #: 17H80CS00172 Program Year: 2022
Criteria
CAMcare’s internal controls over the special tests and provisions compliance area include the financial screening processes and related control activities to complete patient applications during financial screening, including reviewing and approving patient applications and calculating of scale ratings per patient based on annual income and family size.
Condition
During our testing of special tests and provisions, we noted control deficiencies related to the financial screening process; 5 out of 40 patient records sampled showed instances where the patient scale ratings were calculated incorrectly on the patient applications, and for 1 out of 40 samples, the sliding fee discount was applied to a patient visit for which the financial screening application process was not completed.
Cause
Financial screening personnel were not applying control procedures correctly in accordance with their financial screening process.
Effect
Possibility of inaccurate discounts given to patients and significant or material noncompliance with major federal programs.
Questioned Costs
None
Perspective Information
We tested a statistically valid sample of 40 patient visits out of a total population of 250+ uncompensated care program visits and determined that the audit finding represented a systemic problem.
Repeat Finding
This finding is not a repeated finding.
Recommendation
We recommend that management review the financial screening process in place and closely monitor the patient application process to emphasize the importance of correct implementation of control procedures.
Views of Responsible Officials
Management recognizes the deficiency; on November 29, 2023, CAMcare’s CEO, Jillian Hudspeth, and CFO, Christopher Bernardi, agreed with this finding, and explained that Management plans to offer additional training to the Financial Screening Department members and require the department manager to perform a periodic audit of applications.