WELL CARE COMMUNITY HEALTH INC

Criteria – Management is responsible for establishing and maintaining effective internal controls over determining sliding fee discounts and write-offs. Federal grant funds received by the organization required that the Center maintain a sliding fee write-off policy based on income and family size thresholds. Condition – The auditor noted during its testing of sliding fee write-offs that two out of forty sliding fee write-offs were not applied in accordance with the Center’s policy as a result of incorrect income being inputted into the system. Questioned costs – $-0- Context – Grant specific requirements direct the grant recipient to comply with policies surrounding sliding fee discounts. Effect – This condition creates a risk that patients can be under or overcharged for services provided by the Center, which is not in compliance with the Center’s federal grant guidelines. Cause – The cause of this deficiency is related to a human error related to lack of oversight. Recommendation – The auditor recommends that procedures and policies surrounding sliding fee write-offs are reviewed and revised in order to strengthen internal controls to help ensure calculations are done correctly. In addition, the auditor recommends that all system settings surrounding sliding fee write-offs where the write-offs are automatically calculated and applied but still reviewed to make sure calculations are correctly performed and applied. Views of Responsible Officials and Planned Corrective Action – Management concurs with the recommendation and will review the policies and procedures surrounding sliding fee write-offs. Management plans on providing additional training to staff and performing periodic reviews of sliding fee write-offs to ensure compliance with the policies and procedures.