Finding 959052 (2023-001)

Item 2023-001, Special Tests and Provisions - U.S. Department of Health and Human Services, Health Center Cluster Programs (Assistance Listing Numbers 93.224/93.527/COVID-19 93.224). Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient's ability to pay and their eligibility. A patient's eligibility and ability to pay is determined on the basis of the official poverty guidelines, as revised by HHC (42 CFR Sections 51c. 107(b)(5), 56.108(b)(5) and 56.303(f)). The Center should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Condition: When performing our audit, we noted the Center did not properly determine the sliding fee discount category given to certain patients selected for testing based on the sliding fee scale in effect for the year ended June 30, 2023. Cause: There was deficiency in internal controls to ensure that proper sliding fee discounts were being applied to patients in accordance with the Center's sliding fee scale. Effect: The Center did not comply consistently with the special tests and provisions compliance requirement based on the poverty guidelines in effect for the fiscal year 2023. In addition, the Center may not have properly calculated the sliding fee discount given to the patients and the discount given, if any, may not have been based on the patient's ability to pay. Questioned Costs: None. Context: When performing our audit, we noted that the Center did not properly determine the sliding fee discount given to 2 out of 40 patients selected for testing based on the sliding fee scale in effect for the year ended June 30, 2023. Identification of Repeat Finding: Not a repeat finding. Recommendation: We recommend that proper training be given to employees and that sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. View of Responsible Officia: Management will be training all registration personnel in video conference meetings or one on one training sessions. The staff will be trained on how to appropriately monitor and use the sliding fee discounts. Staff will be shown how to maintain the applicable documentation to support the maintenance of the sliding fee discounts. In addition, a team of management and billing staff will be assigned to periodically review the process to ensure the Center always complies with the sliding fee regulations.