Finding 44496 (2022-001)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2022
Accepted
2023-06-07
Audit: 51809
Auditor: Forvis LLP

AI Summary

  • Core Issue: Patients received sliding fee discounts that did not match the Health Center's policy categories.
  • Impacted Requirements: Compliance with sliding fee discount criteria outlined in federal regulations.
  • Recommended Follow-Up: Management should reinforce understanding of the sliding fee scale policy and implement procedures to ensure proper adherence.

Finding Text

Health Center Program Cluster Assistance Listing Numbers 93.224 and 93.527 U.S. Department of Health and Human Services Criteria or Specific Requirement ? Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g); and 42 CFR sections 56.303(f)) Condition ? Patients received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Health Center?s policy. Questioned costs ? None Context ? A sample of 25 patients were tested out of the total population of 152,981 encounters. The sampling methodology used is not and is not intended to be statistically valid. Two patients received a sliding fee adjustment that was inconsistent with the approved policy for the proper sliding fee adjustments based on their income documentation. Effect ? Sliding fee discounts were given to patients that were inconsistent with the Health Center?s sliding fee discount policy. Cause ? The Health Center did not comply with their sliding fee policy. Identification as a repeat finding ? Not a repeat finding Recommendation ? It is recommended that management continue to ensure all personnel understand the sliding fee scale policy and adhere to the requirements and guidelines set forth in the policy. Procedures should be implemented to ensure that eligible patients receive discounts in accordance with the sliding fee scale and the Health Center Program Compliance Manual.

Corrective Action Plan

Description of Finding: Sliding fee discounts were given to 2 of the 25 patients tested that were inconsistent with the Health Center?s sliding fee discount policy. Statement of Concurrence: Shasta Community Health Center (SCHC) management agrees with the finding related to sliding fee discounts being provided to a small number of patients inconsistent with the Health Center?s sliding fee discount policy. The findings suggest that staff miscalculated which discount these patients would qualify for based on the income documented on the sliding fee forms. This miscalculation caused incorrect sliding fee discounts to be provided. Corrective Action: Since the issue here seems to be based on a lack of attention to detail, additional remediation training will be provided to the front desk staff as well as this potential issue will be trained out to the team members responsible for auditing the sliding fee forms. Additionally, we will ensure that a particular emphasis is placed on this process with our new hire training to try and avoid any mistakes that can come from high turnover amongst the front desk staff. Individual Primarily Responsible for Corrective Action: Chief Operations Officer Projected Completion Date: SCHC projects the remediation training to go out at the all staff meeting on June 6th and all relevant personnel will have been trained by that date.

Categories

Special Tests & Provisions

Other Findings in this Audit

  • 44497 2022-001
    Significant Deficiency
  • 44498 2022-001
    Significant Deficiency
  • 620938 2022-001
    Significant Deficiency
  • 620939 2022-001
    Significant Deficiency
  • 620940 2022-001
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $4.86M
93.224 Covid-19 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $3.15M
93.498 Covid-19 Provider Relief Fund and American Rescue Plan (arp) Rural Distribution $1.19M
93.788 Opioid Str $835,713
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $706,915
93.918 Grants to Provide Outpatient Early Intervention Services with Respect to Hiv Disease $259,871
93.958 Block Grants for Community Mental Health Services $139,133
97.024 Emergency Food and Shelter National Board Program $2,690