Finding 52018 (2022-003)

Material Weakness
Requirement
N
Questioned Costs
-
Year
2022
Accepted
2023-01-30

AI Summary

  • Core Issue: There are errors in applying the sliding fee discount schedule for eligible patients, with instances of incorrect discounts and missing applications.
  • Impacted Requirements: Compliance with federal guidelines for health centers, specifically regarding patient fee adjustments based on income.
  • Recommended Follow-Up: Management should review all sliding fee applications, ensure they are up-to-date, and obtain missing applications to correct discrepancies.

Finding Text

2022-003 ? Material Weakness and Noncompliance ? Special Tests. Federal Program: Assistance Listing #93.224 and 93.527, Health Center Program Cluster, Department of Health and Human Services. Criteria: Health Centers must prepare and apply a sliding fee discount schedule so that amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay. Condition: During our testing of sliding fee?s we noted 7 instances out of 40 where the patient was not slid the proper amount based on their level of income. Additionally, out of the 40 sliding fee adjustments tested, we noted 10 instances where the center was not able to locate the sliding fee application for the applicable patient, however a sliding fee adjustment was still applied, as well as one instance where the sliding fee application that was on file for the patient tested was 2 years old and has not been updated. Questioned Costs: N/A. Cause and Effect: There has been significant turnover in the billing department over the past 2 years, as well as implementation of new billing software. Many instances are due to improper documentation or manual error in inputting the patients slide scale. Recommendation: We recommend that management reviews all current sliding fee patient?s and ensure that the center has an up to date sliding fee application for each. If the center is not able to locate the sliding fee application, then we recommend that the center obtains the proper application. Additionally, we recommend that the center reviews current applications to ensure that current patients are being charged the proper sliding fee scale. Views of Responsible Officials: Management agrees with the finding. Corrective Action Plan: See attached corrective action plan.

Corrective Action Plan

Section II Government Auditing Standards Findingd 2022-003. Material Weakness and Material Noncompliance - Special Tests. FMC Comments: FMC Patient Account Department has had significant turnover in the billing department over the past two years, as well as implementation of new software. FMC hire several Temp staff and their turnover and out due to medical issues. Many of the issues are due to improper documentation or manual error in inputting the patients slide scale in the system. Corrective Action: Family Medical will have management or assigned staff to review all the current sliding fee patient's and ensure that the center has an up to date sliding fee application for each. FMC will retrain staff at the Front Desk at each site and require them to provide obtain the proper application and d ocuments. Patient Accounts will review the current application to ensure that the current patients are being charged the proper sliding fee scale. Management will develop a training module with HR to have each staff complete and test out. FMC is working on hiring additional Staff. We expect this to be completed by February 28, 2023. Responsible Staff: Sena Jolliffi and Christine Croley.

Categories

Material Weakness Special Tests & Provisions

Other Findings in this Audit

  • 52019 2022-003
    Material Weakness
  • 52020 2022-003
    Material Weakness
  • 52021 2022-003
    Material Weakness
  • 628460 2022-003
    Material Weakness
  • 628461 2022-003
    Material Weakness
  • 628462 2022-003
    Material Weakness
  • 628463 2022-003
    Material Weakness

Programs in Audit

ALN Program Name Expenditures
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $2.45M
93.498 Provider Relief Fund $212,393
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $28,363