Finding 480482 (2023-001)

Significant Deficiency Repeat Finding

Requirement

Questioned Costs

Year

2023

Accepted

2024-08-05

Audit: 316663

Organization: Richland Medical Center, Inc. D/b/a Central Ozarks Medical Center (MO)

Auditor: Cohnreznick LLP

AI Summary

Core Issue: The Organization failed to apply sliding fee discounts correctly based on patients' income levels.
Impacted Requirements: This violates federal guidelines requiring accurate discount schedules based on patients' ability to pay.
Recommended Follow-Up: Strengthen internal controls to ensure proper calculation and application of sliding fee discounts.

Finding Text

Finding 2023.001: Special Tests and Provisions 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), Grants for New and Expanded Services under the Health Center Program, COVID-19 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 on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5), 56.108(b)(5) and 56.303(f)). The Organization should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Organization's sliding fee scale. Condition The Organization did not always appropriately apply the sliding fee discount based on income levels. Cause The Organization did not have adequate internal controls in place to effectively ensure that patients receive the correct sliding fee discount. Effect The Organization did not comply with the appropriate rules and regulations as per the Uniform Guidance. Questioned Costs None. Context A test of 40 slide fee discount transactions was performed and resulted in six instances of sliding fee discounts not being properly calculated based on the respective patient family size and income or was not in agreement with the supporting documentation. Our sample was a statistically valid sample. Identification as Repeat Finding Yes - Finding 2022.001. Recommendation The Organization should strengthen internal controls in place to effectively ensure that 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.

Corrective Action Plan

Section Ill- Federal Award Findings and Questioned Costs 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), Grants for New and Expanded Services under the Health Center Program and COVID-19 Grants for New and Expanded Services under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Item 2023-001- Special Tests Recommendation The Organization should strengthen internal controls in place to effectively ensure that patients receive the correct sliding fee discount. Repeat Finding Yes Action Taken As of May 1, 2023, the Director of Revenue and/or designee runs a slide fee report daily the reflects everyone that applied the day before. Billing personnel separate the report and audit the files to ensure the correct slide has been applied. The paper application is forwarded to the billing department for a third audit if the application is in order and has been uploaded into the patients' files and then it is manually filed. The CFO will perform random audits and will present to the Board and CEO a quarterly report with the results. In addition, As of July 1, 2023, the Access Coordinators who normally collect and process the slide fee discount program applications are now reporting to the finance department with the Director of Revenue supervising and training staff. In addition, there will now be a Lead Access Coordinator in very clinic that will audit and perform additional training where necessary.

Other Findings in this Audit

480483 2023-001

Significant Deficiency Repeat
480484 2023-001

Significant Deficiency Repeat
480485 2023-001

Significant Deficiency Repeat
480486 2023-002

Significant Deficiency
480487 2023-002

Significant Deficiency
480488 2023-002

Significant Deficiency
480489 2023-002

Significant Deficiency
1056924 2023-001

Significant Deficiency Repeat
1056925 2023-001

Significant Deficiency Repeat
1056926 2023-001

Significant Deficiency Repeat
1056927 2023-001

Significant Deficiency Repeat
1056928 2023-002

Significant Deficiency
1056929 2023-002

Significant Deficiency
1056930 2023-002

Significant Deficiency
1056931 2023-002

Significant Deficiency

Programs in Audit

ALN	Program Name	Expenditures
93.224	Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care)	$768,417
93.268	Immunization Cooperative Agreements	$351,364
21.027	Coronavirus State and Local Fiscal Recovery Funds	$310,073
93.527	Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program	$212,783
93.912	Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement	$209,335
93.778	Medical Assistance Program	$175,746
93.332	Cooperative Agreement to Support Navigators in Federally-Facilitated and State Partnership Marketplaces	$135,284
93.323	Epidemiology and Laboratory Capacity for Infectious Diseases (elc)	$127,538
93.526	Affordable Care Act (aca) Grants for Capital Development in Health Centers	$72,420
93.283	Centers for Disease Control and Prevention_investigations and Technical Assistance	$27,565
93.185	Immunization Research, Demonstration, Public Information and Education_training and Clinical Skills Improvement Projects	$26,064