Finding 975085 (2023-002)

-
Requirement
N
Questioned Costs
-
Year
2023
Accepted
2024-05-29

AI Summary

  • Core Issue: An incorrect calculation of household income led to a patient being charged a lower copay than appropriate.
  • Impacted Requirements: The sliding fee scale must accurately reflect family size and income based on Federal Poverty Guidelines.
  • Recommended Follow-Up: Remind staff about the correct method for calculating annual income to prevent future errors.

Finding Text

Federal Assistance Listing Number 93.224/93.527 Health Center Program Special Tests and Provisions Finding 2023‐002 – Noncompliance Related to Charging Incorrect Sliding Fee Criteria: Fees for health center services are discounted based on gradations in family size and income for individuals and families with incomes above 100% and at or below 200% of Federal Poverty Guidelines. The Center’s sliding fee scale, approved annually by the Board of Directors, is used to determine the patient’s sliding fee. Condition: For one of 25 encounters selected for testing, an incorrect calculation was used to determine the household income, which resulted in the individual being charged a lesser copay than they should have been charged. Cause: Due to a calculation error, the Center calculated a patient’s annual income by multiplying weekly income by 48 weeks instead of 52 weeks. Effect: The patient encounter was discounted to a copay of $30 when the patient qualified for a discounted copay of $35. Questioned Costs: There are no questioned costs. Context: This issue appears to be an isolated instance and is not systemic of a breakdown in internal controls over special tests and provisions. Repeat Finding: This is not a repeat finding. Recommendation: We recommend that all staff involved in reviewing sliding fee applications be reminded of the Center’s policy for calculating annual income based on support provided by a patient.

Categories

Special Tests & Provisions Internal Control / Segregation of Duties

Other Findings in this Audit

Programs in Audit

ALN Program Name Expenditures
10.766 Community Facilities Loans and Grants $340,025
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $8,544
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $419