Finding 551192 (2024-002)

Significant Deficiency

Requirement

Questioned Costs

Year

2024

Accepted

2025-03-31

Audit: 352076

Organization: Total Health Care, Inc. (MD)

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: Provide ongoing training for staff to ensure understanding and adherence to the sliding fee scale policy.

Finding Text

Health Center Program Cluster Assistance Listing Numbers 93.224 and 93.527 U.S. Department of Health and Human Services 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 Questioned cost. Effect or possible effect – Sliding fee balances of the patients were inconsistent with the Organization’s sliding fee discount policy. Context – A sample of 25 encounters were tested out of the total population of 92,082 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 – Not a repeat finding Recommendation – We recommend management continue to train personnel and ensure all personnel understand the sliding fee scale policy and adhere to the requirements and guidelines set forth in the policy. Procedures should be implemented to ensure that eligible patients receive discounts in accordance with the sliding fee scale and the Health Center Program Compliance Manual.

Corrective Action Plan

Total Health Care, Inc. has taken several steps to ensure that the sliding fee discount is applied correctly and appropriately. These steps include monthly review of the intake process, the review of the documents provided by the patient applicants and providing the staff with ongoing training. Organization contact persons responsible for corrective action: Richard Greene, CFO Anticipated completion date: 6/30/25

Other Findings in this Audit

551193 2024-002

Significant Deficiency
551194 2024-002

Significant Deficiency
551195 2024-002

Significant Deficiency
1127634 2024-002

Significant Deficiency
1127635 2024-002

Significant Deficiency
1127636 2024-002

Significant Deficiency
1127637 2024-002

Significant Deficiency

Programs in Audit

ALN	Program Name	Expenditures
93.914	Hiv Emergency Relief Project Grants	$623,924
93.918	Grants to Provide Outpatient Early Intervention Services with Respect to Hiv Disease	$542,726
93.527	Grants for New and Expanded Services Under the Health Center Program	$172,173
93.224	Health Center Program (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care)	$123,142
93.940	Hiv Prevention Activities Health Department Based	$102,873