Audit 380429

Finding No. 2025-001 - Sliding Fee Determination and Related Patient Billing U.S. Department of Health and Human Services Assistance Listing Number 93.224 Consolidated Health Centers Program Cluster Criteria: All section 330-funded health centers must prepare and apply a sliding fee discount schedule (SFDS), which adjusts amounts owed for health center services by eligible patients based on the patient’s ability to pay. The National Health Services Corps (NHSC) statute mandates that NHSC-approved sites “not deny requested health care services, and shall not discriminate in the provision of services to an individual because the individual is unable to pay for the services.” It stipulates, “the entity shall prepare a schedule of discounts (including, in appropriate cases, waivers) to be applied to the payment of such fees or payments. In preparing the schedule, the entity shall adjust the discounts on the basis of a patient’s ability to pay.” (42 U.S.C. § 254g) Condition: As part of our compliance testing procedures for the HRSA 330 grant program, we tested sixty patients billed under a sliding fee discount schedule. Of the patients tested, three (5%) were found to have exceptions in the amount charged to the patient. Cause: In three instances, the patient was assigned the correct sliding discount level, but was not billed the proper amount. Effect: Three patients, out of a sample of sixty patients, were inaccurately billed for the services provided by Union Community Care. Two patients were overbilled by a total amount of $20. One patient was under billed by a total amount of $10. Questioned Costs: None Repeat finding: None Recommendation: Union Community Care has established policies and controls which did not operate effectively in these instances. We recommend that management strengthen and expand the procedures for review of manual data inputs and enhance their training programs on sliding fee scale processes and procedures. View of the Responsible Official: We agree and plan to address this with improved processes, procedures, and training.