Finding Text
2022-004 Special Tests and Provisions Program Information Federal Organization U.S Department of Health and Human Services Assistance Listing Numbers 93.224 & 93.527 Health Center Program Cluster Award Numbers H80CS26623, H8FCS41667, H8DCS35811, H8HCS45016, C8ECS44852, C14CS39779 Criteria OMB 2 CFR 200, Subpart F Compliance Supplement, Part 4, Compliance Requirement N, Special Tests and Provisions states, ?Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patients ability to pay.? [X] Compliance Finding [ ] Significant Deficiency [X] Material Weakness Condition During our testing of sliding fee discounts for health center patients qualifying for reduced charge visits, we identified several incidents in which the sliding fee applied was not consistent with the entities policies based on the patient?s level of income. Context This finding appears to be a systemic problem. A sample size of 25 patients included 10 who did not have the correct sliding fee applied. In addition, 7 of the 10 misapplied sliding fees were due to lack of application on file. Cause Due to turnover in the billing and admitting staff, there was lack of appropriate training relating to the requirements of the sliding fee system to properly administer the sliding fee program. Effect Patients may have been granted the incorrect sliding fee adjustment. Questioned Costs None identified. Recommendation We recommend continued effort in training personnel on applying the appropriate sliding fee discount based on the Organization?s approved policy and in compliance with the OMB Compliance Supplement requirements. An appropriate level of review should be conducted on patient accounts to ensure proper document retention, application of sliding fee discounts, and third-party insurance billing. Views of responsible officials and planned corrective action Management agrees with this finding. Management has already taken steps and has updated the clinic?s Sliding Fee Discount Program, the clinic?s fee schedule, and retraining of staff. See planned corrective actions in the next section of the Schedule of Audit Findings and Questioned Costs.