Finding Text
Health Center Program Cluster; Federal Assistance Listing No. 93.224; U.S.
Department of Health & Human Services; grant number H80CS00562; budget
periods May 1, 2022, through April 30, 2023.
Criteria or specific requirement: Special Tests and Provisions – 42 CFR, Part
56.303(e), (f) and (g). Health centers receiving funds under the Health Center
Program Cluster are required to have prepared a schedule of fees or payments for
the provision of its services designed to cover its reasonable costs of operation
and a corresponding schedule of discounts adjusted on the basis of the patient’s
ability to pay, to make every reasonable effort, including the establishment of
systems for eligibility determination, billing and collection, and to secure from
patients payments for services in accordance with the schedule of fees and
discounts.
Condition: We noted during our testing of compliance with federal awards that
the Center did not apply the sliding fee discounts properly to two patients out of a
sample of 25 patients for the year ended April 30, 2023.
Questioned cost: None.
Context: From financial records for patients treated during the audit period, we
selected 25 discounts for testing. This sample was not, and was not intended to
be, a statistically valid sample. The Center’s management prepared a schedule of
discounts adjusted on the basis of the patient’s ability to pay; such schedule was
periodically updated and approved by the Center’s board of directors; and the
schedule was uploaded into the Center’s billing system. However, there were
errors when comparing the income or family information entered into the system
during the year ended April 30, 2023. For 2 of the 25 accounts selected for
testing, the account had an incorrect discount and nominal fee applied.
Effect: Discounts were not properly applied to patient accounts. Cause: The errors for the two patients’ accounts were due to incorrect system
errors in applying nominal fees which were not being corrected by billing staff.
Identification as a repeat finding, if applicable: Yes.
Recommendation: We recommend management should periodically test the
application of the sliding fee to patient accounts.
Views of responsible officials and planned corrective actions: The accounting
department, under the direction of the chief financial officer, will conduct
monthly audits of random patients’ accounts for whom the sliding fee schedule
has been applied, as well as training for receptionists to minimize errors.
Receptionists have been mandated, along with assistance from internal billing
staff, to review all patients’ accounts (including income verification) at least
annually.