Finding 588216 (2023-001)

Significant Deficiency Repeat Finding
Requirement
N
Questioned Costs
-
Year
2023
Accepted
2024-02-05
Audit: 15605
Organization: Hcc Network (MO)
Auditor: Forvis 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 (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g) and 56.303(f)).
  • Recommended Follow-Up: Management should reinforce understanding of the sliding fee scale policy and implement procedures to ensure compliance with discount guidelines.

Finding Text

Health Center Program Cluster – CFDA Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS26561, February 1, 2023-January 31, 2024 Award No. 6 H80CS26561, February 1, 2022-January 31, 2023 Award No. 1 H8FCS41198, April 1, 2021-March 31, 2023 Award No. 6 C14CS39928, September 1, 2020-August 31, 2023 Award No. 1 H8HCS44996, September 1, 2021-August 31, 2022 Award No. 6 H8HCS44996, September 1, 2022-August 31, 2023 Award No. 6 H2ECS45563, May 1, 2022-April 30, 2023 Award No. 6 H2ECS45563, May 1, 2023-April 30, 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. Questioned cost – None Context – A sample of 40 patients were tested out of the total population of 23,865 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. Effect – Sliding fee discounts were given to patients that were inconsistent with the Organization’s sliding fee discount policy. Cause – The Organization did not comply with their sliding fee policy. Identification as a repeat finding, if applicable – Is a repeat finding of 2022-002. Recommendation – We recommend management continue to 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.

Categories

Special Tests & Provisions

Other Findings in this Audit

  • 11773 2023-001
    Significant Deficiency Repeat
  • 11774 2023-001
    Significant Deficiency Repeat
  • 11775 2023-001
    Significant Deficiency Repeat
  • 11776 2023-002
    Material Weakness
  • 588215 2023-001
    Significant Deficiency Repeat
  • 588217 2023-001
    Significant Deficiency Repeat
  • 588218 2023-002
    Material Weakness

Programs in Audit

ALN Program Name Expenditures
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $2.07M
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $1.76M
93.493 Congressional Directives $1.24M
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $843,894
10.766 Community Facilities Loans and Grants $477,299
32.006 Covid-19 Telehealth Program $285,872
93.526 Affordable Care Act (aca) Grants for Capital Development in Health Centers $223,122
93.778 Medical Assistance Program $144,860
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $107,114
93.107 Area Health Education Centers Point of Service Maintenance and Enhancement Awards $103,876
93.322 Csels Partnership: Strengthening Public Health Laboratories $100,000
93.332 Cooperative Agreement to Support Navigators in Federally-Facilitated and State Partnership Marketplaces $54,566
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $16,966
93.800 Organized Approaches to Increase Colorectal Cancer Screening $13,967
93.969 Pphf Geriatric Education Centers $8,000
21.027 Coronavirus State and Local Fiscal Recovery Funds $1,050