Finding 952076 (2022-002)

Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we found two errors in the sliding fee category. In one instance, a patient was improperly billed for a sliding fee level they were not eligible for based on support provided with their application. In the second instance, no supporting eligibility application and income verification were maintained by the Clinic to support the sliding fee scale adjustment the patient received. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in improper client billing and loss of revenue. Context: During our testing, we found 2 of the 40 patients tested were not billed for the proper slide category based on the FY2022 sliding fee scale provided by the Clinic. No questioned costs were identified. Cause: The Clinic had no form of secondary review in place, resulting in the errors in billing or improper documentation not being detected and corrected in a timely manner. Recommendation: We recommend a secondary review of the applications and system input to ensure the patient is placed into and billed for the correct slide category within the software and proper documentation is verified in the electronic health records to support the slide eligibility. Management Response: See Corrective Action Plan.