Finding Text
Program Affected: Direct Award - Department of Health and Human Services: Health Center Program Cluster (Health Center Program CFDA No. 93.224 and Grants for New and Expanded Services under the Health Center Program CFDA No. 93.527). Grant No. H80CS00035, with grant periods February 1, 2021 through January 31, 2022, and February 1, 2022 through January 31, 2023. Questioned Costs: None Condition: The Organization?s sliding fee scale policy provides for the application of discounts to eligible patients based on the ability to pay. The Organization has designed an internal control to provide a review and approval of eligibility determinations within the established sliding fee scale based on income and family size. During our testing of participants, it was noted that 4 out of the 40 individuals sampled and tested did not have evidence that the internal control designed had been applied to the determination of eligibility within the sliding fee scale framework, leading to incorrect determinations of appropriate application of the sliding fee scale. Criteria: 42 CFR Sections 51c.303(e), (f), and (g) require a health center to apply sliding fee discounts to patients consistent with its sliding fee discount schedule. The Uniform Guidance requires grantees to design and implement internal controls over compliance to prevent, or detect and correct noncompliance with compliance requirements. Cause: The Organization?s monitoring and approval process did not appropriately detect errors in applications for four individuals. Effect: The internal control did not operate effectively, and that failure created a risk that individuals could be charged incorrectly. Recommendation: Wipfli LLP recommends the Organization to review its internal process for approval of the sliding fee scale calculation and determine that the review is performed to prevent, or detect and correct errors in data entry. Views of responsible officials: We agree with the finding have had already implemented corrective action during the current fiscal year.