Finding Text
Federal Agency: Department of Health and Human Services
Federal Program: 93.224 Health Center Program
Identification Numbers: H80CS29007
H8DCS36329
H8ECS38904
H8FCS41132-01-00
Requirement: Special Tests and Provisions
Type of Finding: Significant deficiency in internal control over major program; Noncompliance
Criteria: Patient charges are adjusted based on income and family size by applying the Health Center’s sliding fee discount schedule.
Condition: Sliding fee discounts are not applied appropriately for all patients.
Cause: There is no management oversight in this area. Also, employees have not been properly trained and are not consistently utilizing the Allscripts software that maintains patient data.
Effect: The Health Center is not compliant with federal regulations which could result in the federal government imposing additional requirements or withholding, disallowing or suspending grant funds.
Context: Out of the 60 patients selected for testing, 12 were charged less than they should have been, 5 patients were charged more than they should have been and 4 patients were unable to be tested due to a lack of documentation.
Repeat Finding: This finding was reported for the year ended June 30, 2021 as 2021-006.
Recommendation: All elements required for the sliding fee discount should be properly maintained in Allscripts, including documentation of zero household income. Employees should be properly trained on the software, and a user manual should be created related to patient intake so patient records are consistent and documented appropriately. The sliding fee discount noted in Allscripts should correspond to the co-pay amount listed on patient billings. Health Center staff in charge of billing should review the patient data to ensure the correct adjustment was made and patients were charged the correct co-pay amount. Any discrepancies should be brought to the attention of Health Center management before bills are processed.
Views of Responsible Official(s) and Planned Corrective Actions: See corrective action plan.