Audit 382377

Sliding Scale Assessment Billing Significant Deficiency U.S. Department of Health and Human Services ALN #: 93.224 Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) Federal Award Identification #: H80CS6674 Condition: The sliding scale assessment based on a patient's ability to pay was not always applied properly for patient’s billing. Additionally, the sliding scale assessment documentation was not always retained to support patient's billing. Criteria: 42 CFR Part 51c.303 (f) Questioned Costs: $0 Context: Out of 40 patients tested that had a sliding scale assessment, 38 patients had the correct sliding fee assessment completed; however, for the visit tested, the billing did not reflect the correct sliding fee. Additionally, 2 patients did not have proper documentation retained for the sliding fee assessment completed. Cause: Human error. Effect: Non-compliance with federal regulations. Identification as repeat finding, if applicable: Yes, 2024-003 Recommendation: We recommend LACHC implement additional checks and balances for patient billing and ensure all supporting documentation be retained to prevent sliding fee billing errors. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. See corrective action plan.