Finding 513847 (2023-002)

Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Center Program Cluster Assistance Listing Numbers: 93.224 and 93.527 Federal Award Identification Number and Year: H80CS00109-21; H80CS00109-22 Award Period: May 1, 2022 – April 30, 2023; May 1, 2023 – April 30, 2024 Type of Finding: Material Weakness in Internal Control over Compliance and Material Noncompliance Criteria or specific requirement: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. (42 USC 254(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)). Condition: The Organization did not maintain documentation to show that patients had been evaluated for eligibility under its sliding fee scale policy and did not assign patients a sliding fee category. Questioned costs: None. Context: Twenty-five (25) of forty (40) encounters did not have current documentation of family size and income to assess sliding fee discount eligibility, and twenty-five (25) of twenty-five (25) were not assigned a sliding fee category. Cause: This matter was identified during a prior audit and corrected during the second half of calendar year 2023. As a result of when this matter was first identified, corrective active was not able to occur prior to the year ended June 30, 2023 audit. Corrective action occurring during the second half of calendar year 2023. Effect: Patients may not be assessed a correct sliding fee discount according to the Organization's sliding fee scale and their ability to pay. Repeat Finding: Yes, prior year finding 2022-003. Recommendation: Management should continue to work with its third-party vendors to ensure the accuracy and completeness of the patient information within its billing software in addition to continuing to conduct internal audits of patient visits to determine all required patient information has been obtained in accordance with TCA’s policies. Views of responsible officials: There is no disagreement with this finding.