Audit 384777

Health Center Program Cluster; Federal Assistance Listing No. 93.224 and 93.527; HHS; grant number H80CS08782; budget period May 1, 2024 to April 30, 2025. Criteria or specific requirement: Special Tests and Provisions – 42 CFR, Part 56.303(e), (f) and (g). Health Centers receiving funds under the Health Center Program Cluster are required to prepare a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts adjusted on the basis of the patient’s ability to pay, to make every reasonable effort, including the establishment of systems for eligibility determination, billing and collection, and to secure from patient payments for services in accordance with the schedule of fees and discounts. Condition: We noted the Health Center did not properly apply the sliding fee discounts approved by the board of directors for 2 patients, out of a sample of 40 patients tested for the year ended June 30, 2025. Cause: The Health Center did not comply with its sliding fee policy due to posting errors in the system and inconsistencies between the application and information entered into the system. Effect or Potential Effect: Discounts were not properly applied to patient accounts. Questioned costs: None Context: From a total of 4,541 sliding fee discounts for the period, 40 discounts were selected for testing. This sample was not, and was not intended to be, a statistically valid sample. The Health Center’s management did prepare a schedule of discounts adjusted on the basis of the patient’s ability to pay; such schedule was updated and approved annually by the Health Center’s board of directors. However, there were errors when comparing the approved schedule to certain actual adjustments to patients accounts and the patients supporting documentation during the year ended June 30, 2025. Identification as a repeat finding, if applicable: Repeat finding, 2024-001 Recommendation: All personnel involved in the sliding fee discount program should demonstrate their understanding of the sliding fee scale policy and receive appropriate training during the year. We also recommend internal review of patient accounts and sliding fees applied during the year. Views of responsible officials and planned corrective actions. The Health Center agrees with the finding. See separate report for planned corrective action.