Finding 618880 (2022-001)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2022
Accepted
2023-06-08
Audit: 39703
Organization: Presbyterian Medical Services (NM)
Auditor: Redw LLC

AI Summary

  • Core Issue: Inaccurate income documentation for patients led to incorrect application of the sliding fee discount schedule.
  • Impacted Requirements: Compliance with 42 USC 254(k)(3)(E), (F), and (G) regarding proper income verification for eligible patients.
  • Recommended Follow-Up: Management should enhance training on income documentation and conduct regular spot checks to ensure accuracy.

Finding Text

Federal program information: Funding agency: U.S. Department of Health and Human Services Title: Health Center Program Cluster Assistance listing numbers: 93.224 and 93.527 Award year and number: 2022; H80CS00205-21-00; H80CS00205-21-01 Criteria: According to 42 USC 254(k)(3)(E), (F), and (G), 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: Documentation supporting income verification for eligible patients did not agree to the income amounts applied to the sliding fee discount schedule. The amount of income applied to the sliding fee discount schedule was either estimated or rounded down. Questioned Costs: None. Context: Of a sample of 25 patients who received sliding fee discounts, five patients did not have documentation of income supporting the amounts used in applying the sliding fee discount schedule. Cause: Documentation of patient income was not accurately documented at the time of intake as a result of staffing turnover. Effect: Without accurate documentation of patient income, the sliding fee discount was not correctly applied. Auditor?s Recommendations: Management should reiterate the importance of using accurate documentation of patient income when applying the sliding fee discounts. Management should consider providing additional training to staff over the patient intake process and perform periodic spot checks to verify the accuracy of patient income.

Categories

No categories assigned yet.

Other Findings in this Audit

  • 42438 2022-001
    Significant Deficiency
  • 42439 2022-001
    Significant Deficiency
  • 42440 2022-001
    Significant Deficiency
  • 618881 2022-001
    Significant Deficiency
  • 618882 2022-001
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.600 Head Start $15.99M
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $14.50M
93.224 Covid-19 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $6.04M
93.526 Covid-19 Affordable Care Act (aca) Grants for Capital Development in Health Centers $1.33M
93.600 Covid-19 Head Start $514,171
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $238,020
93.053 Nutrition Services Incentive Program $115,315
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $47,257
93.045 Covid-19 Special Programs for the Aging_title Iii, Part C_nutrition Services $33,238
93.053 Covid-19 Nutrition Services Incentive Program $8,163
93.527 Covid-19 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $6,089