Finding 586106 (2023-002)

Federal Organization: U.S Department of Health and Human Services Assistance Listing Numbers: 93.224 & 93.527 Health Center Program Cluster Award Numbers: H80CS26583, H8FCS41666 Criteria : Compliance Finding Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart F, Compliance Supplement, Part 4, Compliance Requirement N, Special Tests and Provisions states, “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 (discounted) based on the patients ability to pay.” Condition: During our testing of sliding fee discounts for health center patients qualifying for reduced charge visits, we identified one incident where the slide fee was applied to a patient account without a completed application on file and three incidents in which the incorrect sliding fee was applied. Context: This finding appears to be a systemic incident. A sample size of 25 patients included one without an application on file and three which did not have the correct sliding fee applied. Cause:The Organization did not follow its policies and procedures set in place to ensure the sliding fee schedule discount is correctly determined and applied to patient accounts. Effect: Patients may have been granted the incorrect sliding fee discount Questioned Costs: There were no questioned costs identified Recommendation: We recommend continued effort in training personnel to be properly trained on applying the appropriate sliding fee discount based on the Organization’s approved policy and in compliance with the OMB Compliance Supplement requirements. An appropriate level of review should be conducted on patient accounts to ensure proper document retention, application of sliding fee discounts, and third-party insurance billing. Views of Responsible Officials and Planned Corrective Action: CrescentCare agrees with the finding and has put staff and procedures in place to prevent these incidents from occurring.