Audit 394694

Criteria or Specific Requirement Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges and designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted based on the patient’s ability to pay. The patient’s ability to pay is determined based on the official poverty guidelines, as revised annually by HHS. The poverty guidelines are issued each year in the Federal Register and HHS maintains a web page that provides the poverty guidelines. Condition The Center determines the amount of fees to be charged to a patient based on the patient’s income, expenses and number of dependents in conjunction with the sliding fee schedule. Of the 17 patients selected for testwork, we noted that the Center charged the incorrect sliding fee amount for two (2) patients, which resulted in overcharging the two (2) patients by a total of $10. These two transactions occurred prior to March 31, 2025. In assessing the Center’s corrective action plan (CAP) for the prior year finding F2023-002, we noted that the CAP was implemented on March 31, 2025. This finding is noted as a repeat finding due to the timing of the audit process. The audit report for the prior year was issued on March 31, 2025. Therefore, the identified condition noted in the prior year finding F2023-002 existed for the majority of fiscal year 2025. Questioned Costs $10 in total overcharges for sliding fee patients sampled. Causes and Effects The potential causes for the above errors are as follows: • Errors by staff in determining the patient’s ability to pay. • Patients did not complete the required form necessary to determine the patient’s ability to pay. • Lack of sufficient documentation to support the determination of the fee amount charged to the patient. As a result, the determination supporting patients’ fees is not consistent with the sliding fee schedule. Recommendation We recommend that the Center’s procedures for the determination of sliding fees be strengthened to ensure 1) income is properly verified and adequately documented and 2) the sliding fee discount is properly determined and applied. The Center should also provide additional training to staff involved in the sliding fee process and ensure that appropriate individuals are properly monitoring and reviewing the Center’s compliance with program requirements. This will help ensure that the proper sliding fee is charged to patients and that program goals and objectives are being met.