Finding 620939 (2022-001)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2022
Accepted
2023-06-07
Audit: 51809
Auditor: Forvis LLP

AI Summary

  • Core Issue: Patients received sliding fee discounts that did not match the Health Center's policy categories.
  • Impacted Requirements: Compliance with sliding fee discount criteria outlined in federal regulations.
  • Recommended Follow-Up: Management should reinforce understanding of the sliding fee scale policy and implement procedures to ensure proper adherence.

Finding Text

Health Center Program Cluster Assistance Listing Numbers 93.224 and 93.527 U.S. Department of Health and Human Services 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 Health Center?s policy. Questioned costs ? None Context ? A sample of 25 patients were tested out of the total population of 152,981 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 Health Center?s sliding fee discount policy. Cause ? The Health Center did not comply with their sliding fee policy. Identification as a repeat finding ? Not a repeat finding Recommendation ? It is recommended that 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

  • 44496 2022-001
    Significant Deficiency
  • 44497 2022-001
    Significant Deficiency
  • 44498 2022-001
    Significant Deficiency
  • 620938 2022-001
    Significant Deficiency
  • 620940 2022-001
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $4.86M
93.224 Covid-19 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $3.15M
93.498 Covid-19 Provider Relief Fund and American Rescue Plan (arp) Rural Distribution $1.19M
93.788 Opioid Str $835,713
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $706,915
93.918 Grants to Provide Outpatient Early Intervention Services with Respect to Hiv Disease $259,871
93.958 Block Grants for Community Mental Health Services $139,133
97.024 Emergency Food and Shelter National Board Program $2,690