Finding Text
Finding – 2024-002 – Special Tests and Provisions – Material Weakness in Internal Control over
Compliance
Criteria: The recipient is required to comply with specific federal regulations and provisions outlined in
2 CFR Part 200, particularly those related to special tests and provisions for the Health Center Program
Cluster. This includes maintaining an effective internal control environment to ensure sliding fee discounts
are applied to patient charges consistent with the recipients sliding fee discount schedule.
Condition/cause: During the audit, it was identified that the sliding fee discounts for health center
patients qualifying for reduced charge visits was not consistently applied for patients based on
qualification criteria. This was due to turnover in the billing and admitting departments and an overall a
lack of appropriate training over the federal program compliance requirements.
Effect or potential effect: Certain patients were billed amounts different than the amounts defined by the
sliding fee discount schedule.
Questioned costs: None identified.
Context: We selected a sample of 25 patient visits from a statistically valid population of patients
potentially eligible for benefits under the sliding fee schedule during the fiscal year ended June 30, 2024.
In 3 out of 25 samples tested, the Organization’s system limitations resulted in patients being billed less
than the amounts defined by the sliding fee discount schedule.
Repeat finding: Yes, see Finding 2023-002
Recommendation: We recommend the Organization implement an effective process and a
comprehensive training of the process to ensure that the sliding fee scale is accurately applied to all
qualifying program participants. Additionally, we would recommend the Organization perform regular
reviews to ensure there are no issues with the system.
Views of responsible officials: Management is in agreement with this finding. See corrective action
plan.