FAC Explorer

Finding 547940 (2024-003)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2025-03-31
Audit: 351868
Organization: New River Health Association, Inc. (WV)
Auditor: Forvis Mazars LLP

AI Summary

  • Core Issue: Patients received sliding fee discounts that did not match the organization's policy.
  • Impacted Requirements: Compliance with sliding fee discount criteria as outlined in federal regulations.
  • Recommended Follow-Up: Ensure staff understand the sliding fee policy and update sliding fee scales annually; management is addressing workflow corrections by 12/31/2025.

Finding Text

Health Center Program Cluster – CFDA Nos. 93.224 and 93.527 Health Center Program Cluster – ALN Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS00075, April 1, 2024 - March 31, 2025 Award No. 2 H80CS00075, April 1, 2023 - March 31, 2024 Award No. 4 H8FCS41116, April 1, 2021 - March 31, 2024 Award No. 4 H8GCS48805, December 1, 2022 – June 30, 2024 Award No. 1 H8LCS51581, September 1, 2023 – December 31, 2024 Criteria or Specific Requirement – Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g); and 42 CFR sections 56.303 (f)) Condition – Patients received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization’s policy. Cause – The Organization did not comply with their sliding fee policy. Effect or potential effect– Sliding fee discounts were given to patients that were inconsistent with the Organization’s sliding fee policy. Questioned costs – None Context – A sample of 25 encounters were tested out of the total population of 290,121 encounters. The sampling methodology used is not and is not intended to be statistically valid. Two patients received a sliding fee adjustment that was inconsistent with the approved policy for the proper sliding fee adjustments based on their income documentation. Identification as a repeat finding, if applicable – N/A Recommendation – We recommend management continue to ensure all personnel understand the sliding fee policy and adhere to the guidelines set forth in the policy. Additionally, we recommend the client ensure the sliding fee scales within their systems are updated annually and in a timely manner. View of Responsible Officials and Planned Corrective Actions – Management will work with Athena to correct the workflow to ensure slide fees are adjusted at the correct updated Federal Poverty Level at the beginning of the new year. Organization’s contact persons responsible for corrective action: Michele Sarrett Anticipated completion date: 12/31/2025

Corrective Action Plan

Management will work with Athena to correct the workflow to ensure slide fees are adjusted at the correct updated Federal Poverty Level at the beginning of the new year. Organization contact persons responsible for corrective action: Michele Sarrett Anticipated completion date: 12/31/2025

Categories

Special Tests & Provisions

Other Findings in this Audit

  • 547937 2024-002
    Significant Deficiency
  • 547938 2024-002
    Significant Deficiency
  • 547939 2024-002
    Significant Deficiency
  • 547941 2024-003
    Significant Deficiency
  • 547942 2024-003
    Significant Deficiency
  • 1124379 2024-002
    Significant Deficiency
  • 1124380 2024-002
    Significant Deficiency
  • 1124381 2024-002
    Significant Deficiency
  • 1124382 2024-003
    Significant Deficiency
  • 1124383 2024-003
    Significant Deficiency
  • 1124384 2024-003
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.224 Health Center Program (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $701,678
93.493 Congressional Directives $322,398
93.965 Coal Miners Respiratory Impairment Treatment Clinics and Services $223,000
93.870 Maternal, Infant and Early Childhood Home Visiting Grant $212,500
93.527 Grants for New and Expanded Services Under the Health Center Program $169,822
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $97,500
93.994 Maternal and Child Health Services Block Grant to the States $86,000
93.800 Organized Approaches to Increase Colorectal Cancer Screening $43,087
93.859 Biomedical Research and Research Training $40,000
93.590 Community-Based Child Abuse Prevention Grants $2,006