Audit 369470

Finding Number: 2025-001 Finding Type: Internal Control over Compliance – Special Tests and Provisions (Sliding Fee Discounts) Information on the Federal Program: Cluster Name: Health Center Cluster – 330 Grant Federal Awards: H80CS00311 Federal Agency: U.S. Department of Health and Human Services Criteria: Federal grant compliance provisions require that the Organization correctly identify a patient's ability to pay and that the rates for services be adjusted accordingly based on the sliding fee schedule. The Organization is required to follow its sliding fee policy when providing discounts to eligible patients. Condition: The Organization did not have a record of the sliding fee application used to determine sliding fee eligibility for six patients selected for testing. Questioned Costs: None Repeat Finding: No Cause and Effect: The Organization does not have procedures in place to ensure that sliding fee applications are electronically scanned and filed. Sliding fee applications are reviewed by one individual and a sliding fee level determination is entered into the patient’s medical records and the Organization’s billing software, but there is no documented process for a second individual at the Organization to verify that the application was filed and the sliding fee level for that patient was appropriately entered into the patient’s medical records. Lack of strict enforcement of the policy of sliding fee eligibility determination and compliance may have resulted in the Organization providing discounted services greater to or less than the appropriate amounts to beneficiaries. Recommendation: The Organization should establish a review process for all patient information entered into the Organization’s billing software to ensure that a sliding fee application is on file and the sliding fee applied to the patient is in line with the information verified on the application. Views of Responsible Official and Corrective Action Plan Management acknowledges and understands this finding. A response to the finding is noted in the Corrective Action Plan on page 40.