Finding 516965 (2024-001)

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Requirement
E
Questioned Costs
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Year
2024
Accepted
2024-12-27

AI Summary

  • Core Issue: PATHS incorrectly approved applications for sliding scale benefits, leading to inappropriate eligibility determinations.
  • Impacted Requirements: Federal income eligibility guidelines were not followed, affecting the accuracy of benefits assigned.
  • Recommended Follow-Up: Strengthen controls to ensure accurate data entry in the online software; PATHS plans to take corrective action in FY24.

Finding Text

Program: Health Center Program Cluster (Assistance Listing Number 93.224/93.527) Criteria: Applicants who meet the published federal income eligibility guidelines are eligible for sliding scale benefits. Condition: Fifteen applications were selected for testing. PATHS incorrectly approved two applications for Slide A status, when they should have been approved for Slide C status. One application was approved for Slide D status, when it should have been rejected. Cause: Household income and family size data were incorrectly calulcated when determining sliding scale status. Effect: Applicants were not approved or denied appropriately. Recommendation: Controls should be strengthened to ensure that the amounts entered into the online software are accurate. Views of Responsible Officials: PATHS is considering corrective action for FY24.

Corrective Action Plan

Controls have been strengthened to ensure that front desk accurately enters applicant's income and family size into ECW for determining eligibility for the sliding fee schedule. A new policy and procedure will be implemented as follows: To esnure that all staff are properly trained and following Policy 02-02-013 Patients applying for a sliding fee. A mandatory training will be done January 14th and 15th to include all site managers, operations managers, CFO, and COO. The compliance officer will perform a monthly audit. The audit will be submitted to the risk manager quarterly. The front desk trainer will provide additional training to any person who receives a fail on the audit. This training will be signed off by the employee, front desk trainer, and their supervisor. Discipline will be the following: 1st occurrence one on one training 2nd occurrence a verbal warning and additional training 3rd occurrence a written warning 4th occurrence up to termination

Categories

Eligibility

Other Findings in this Audit

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) $4.58M
93.495 Community Health Workers for Public Health Response and Resilient $240,330
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $163,227
93.107 Area Health Education Centers Point of Service Maintenance and Enhancement Awards $106,448
93.526 Affordable Care Act (aca) Grants for Capital Development in Health Centers $47,289