Finding Text
Finding 2022-001: Special Tests and Provisions - Significant Deficiency - Failure to Update and Apply the Sliding Scale Federal Assistance Listing Number: 93.224/93.527- Health Center Program [including Covid-19 funds] Federal Agency: U.S. Department of Health and Human Services Federal Award Numbers: H80CS00313-13-12; H8FCS41390-01-00, H2ECS45521-01-00 Federal Award Year: January 1, 2022- December 31, 2022 Pass-Through Entity: Hudson River Health Care Criteria: Under 42 CFR Sections 51c.303(e), (f) and (g), 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 based on the patient's ability to pay. To verify this criteria, the compliance supplement has the suggested audit procedures which require the auditor to review a sample of patients treated. LIFQHC should maintain patient files to support the patient's eligibility and that the patient charges were appropriately adjusted based on income and family size by appropriately applying LIFQHC's sliding fee discount schedule. Questioned Cost: None Condition: 3 out of 40 selected patients receiving healthcare under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category. Context: We recalculated the annual income thresholds utilizing the patient files to validate the sliding fee scale in which the patients were categorized. 3 out of 40 selected patients receiving healthcare services under the sliding fee arrangement had income which did not align with the sliding scale category, and therefore, were not charged appropriately based on the appropriate sliding scale category. This was not a statistically valid sample. Effect: 3 out of 40 patients were not charged the appropriate fees based on their income levels. Incorrect payment amount was received per the sliding fee scale. This is a significant deficiency in internal controls. Cause: A review was not performed to verify that annual patient income was input correctly. The updated sliding fee scale was not uploaded and utilized timely. Recommendation: We recommend that LIFQHC continue to implement procedures to ensure that the sliding fee scale is appropriately charged to every patient and that an annual verification is performed. Procedures should also be implemented to validate the accuracy of the annual patient income for sliding scale categorization purposes. The updated sliding fee scale should be approved by the board and updated timely. Views of Responsible Officials and Planned and Corrective Actions: LIFQHC has implemented procedures to ensure that all patients are charged appropriately based on services, income and where they should be categorized on the LIFQHC sliding fee scale. Management is currently providing training to the registration staff across all sites. The objective of this training is to verify patients' information, such as income, in order to ensure that all patients are charged appropriately. All the above findings were happened before the training was provided. Management has also implemented a new process in which the sliding fee scale will be updated on a more timely basis. LIFQHC will update the sliding fee scale in the electronic medical record system as soon as the current year's poverty guidelines are available. Responsible Party: Savitree Pestano, Chief Financial Officer Estimated Time of Completion: December 31, 2022