Finding Text
FINDING 2020-007
Lack of Adequate Documentation for Application of Sliding Fee Discounts to Patient
Charges with Sliding Fee Discount Schedule
FEDERAL PROGRAM
Health Centers Program (Health Centers Cluster)
CFDA NUMBER AND TITLE
93.224 - Consolidated Health Centers (community health centers, migrant health centers,
health care for the homeless, and public housing primary care centers)
93.527 - Affordable Care Act (ACA) grants for new and expanded services under the health
center program.
FINDING TYPE
Noncompliance, material weakness in internal control over compliance.
Criteria
QCHC is required to prepare a sliding fee discount schedule and apply the appropriate
calculated discount so that the amounts owed for health services by eligible patients are
adjusted (discounted) based on the patient’s ability to pay.
CONDITION AND CONTEXT
During the audit of the financial statements for the fiscal year ended July 31, 2020, QCHC
was unable to provide adequate documentation to support the applied sliding fee discounts
to patient charges in accordance with the sliding fee discount schedule.
CAUSE
In February 2020, the Organization was victim of a database breach which corrupted the
Organization’s servers and resulted in the loss of general ledger and patient service data
dating through February 2020. QCHC was unable to recover adequate documentation to
support patient services.
EFFECT OR POTENTIAL EFFECT
By not retaining the correct sliding fee discounts to patients charges documentation,
patients may not have been charged the proper amount for their services. This finding is a
material weakness in internal control over compliance and noncompliance with the
Uniform Guidance.
RECOMMENDATION
We recommend management improve their documentation retention processes to support to
support individuals who receive the sliding fee discount.
Views of Responsible Officials and Planned Corrective Action
See the attached response and corrective action plan.