Finding 516578 (2024-001)

Finding 2024-001: Special test and provisions - Sliding Fee Discounts – Significant Deficiency Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster Community Health Centers COVID-19 Community Health Centers Affordable Care Act (ACA) Grant for New and Expanded Services Under the Health Center Program COVID-19 Affordable Care Act (ACA) Grant for New and Expanded Services Under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Federal Award Identification Number and Year: H802900 – 2023 and 2024, H8F41226 – 2021, H8G47702 – 2023, H8L51715 - 2024 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 slide fee discounts issued to patients in accordance with the Organization's sliding fee scale. Condition The Organization did not always calculate the proper slide fee discount based on approved policies. Cause The Organization did not have adequate internal controls in place to effectively ensure that patients received the correct sliding fee discount. Effect or Potential 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 four instances of a sliding fee discount not being properly calculated based on the respective patient family size and income. Our sample was a statistically valid sample. Identification as a Repeat Finding This finding is not a repeat finding. Recommendation The Organization should establish a system of internal controls to ensure that all patients receive the correct sliding fee discount. Views of Responsible Officials Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.