Finding 576025 (2024-001)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2025-09-09

AI Summary

  • Core Issue: Health centers failed to apply the correct sliding fee discounts for eligible patients, leading to incorrect billing.
  • Impacted Requirements: Compliance with the sliding fee discount schedule under Assistance Listing Numbers 93.224 and 93.527 was not met.
  • Recommended Follow-Up: Implement a second-level independent review of patient data and income verification to ensure accurate financial classifications.

Finding Text

Federal Agency: U.S Department of Health and Human Services Federal Program Name: Health Center Program Cluster Assistance Listing Number: 93.224 and 93.527 Award Period: 1/1/2024 – 12/31/2024 Type of Finding: Significant Deficiency in Internal Control over Compliance and Compliance Criteria or specific requirement: Under the compliance requirement for Special Tests and Provisions for ALN 93.224-93.527, “health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay”. Condition: Encounters eligible for a sliding fee adjustment did not receive the appropriate adjustment per the patient’s approved sliding fee discount level. Context: During our testing of sliding fee discounts for health center patients qualifying for reduced charge visits, we identified three visits in a sample of forty, which received the incorrect sliding fee discount. We did not proceed with testing after instances were identified. Cause: Internal control process and procedures were not followed resulting in a discount applied in the billing system that did not match the sliding fee determination per the approved patient application. Effect: Patient would receive an incorrect sliding fee discount. Recommendation: We recommend implementation of a second level independent review of the demographic data and income verification information entered into the patient billing system in order to ensure the financial classification is correct. Views of responsible officials: There is no disagreement with the audit finding.

Corrective Action Plan

2024-001 Health Center Program Cluster– Assistance Listing Nos. 93.224 and 93.527 Recommendation: PCHC should implement a second level independent review over demographic data and income verification information entered into the patient billing system in order to ensure the financial classification is correct. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Front desk receptionist and Enrollment staff were retrained on the sliding fee discount scale and the federal poverty level policy and procedure. Commencing in August 2025, PCHC implemented a weekly internal review process of prior period patient sliding fee applications and approved slide adjustment calculations. Weekly audits of patient applications are conducted under the supervision of management to ensure the financial classification is correct. Improvements will be reported quarterly at the Board of Directors Finance Committee meetings. Name(s) of the contact person(s) responsible for corrective action: Alfonso Aguilera, Chief Financial Officer Planned completion date for corrective action plan: 12/31/2025.

Categories

Special Tests & Provisions Significant Deficiency Internal Control / Segregation of Duties

Other Findings in this Audit

  • 576026 2024-001
    Significant Deficiency
  • 576027 2024-001
    Significant Deficiency
  • 576028 2024-001
    Significant Deficiency
  • 576029 2024-002
    Significant Deficiency
  • 576030 2024-002
    Significant Deficiency
  • 576031 2024-002
    Significant Deficiency
  • 576032 2024-002
    Significant Deficiency
  • 1152467 2024-001
    Significant Deficiency
  • 1152468 2024-001
    Significant Deficiency
  • 1152469 2024-001
    Significant Deficiency
  • 1152470 2024-001
    Significant Deficiency
  • 1152471 2024-002
    Significant Deficiency
  • 1152472 2024-002
    Significant Deficiency
  • 1152473 2024-002
    Significant Deficiency
  • 1152474 2024-002
    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) $590,218
93.526 American Rescue Plan Act Funding for Health Centers - Grants for Capital Development $298,896
93.527 Fy 2023 Bridge Access Program $40,104
93.527 Grants for New and Expanded Services Under the Health Center Program $36,446
93.493 Congressional Directives $2,669