Audit 398547

Sliding Fee Discount Documentation and Application of Policies – Significant Deficiency 2024-003 Federal Program Identification :U.S. Department of Health and Human Services Health Centers Cluster – Health Center Program and Affordable Care Act – Grants for Expanded Service, AL 93.224 and 93.527, Grant number H8026592 Condition/Criteria: Community Health Centers are required to offer sliding fee discounts to patients with annual incomes at or below 200% of the federal poverty guidelines. While the Organization has established policies to administer these discounts, opportunities exist to strengthen controls, particularly in documentation practices and application of the policy. Supporting documentation used to determine sliding fee discounts is not consistently maintained in every patient file. Application of the policy guidelines to determine discounts was not consistent. Cause: The Organization experienced constraints resulting from significant growth and various other unforeseen circumstances during the year. Effect: Without proper documentation and consistent application, there is a risk that patients may receive incorrect sliding fee discounts, potentially resulting in overpayment or underpayment for services. Recommendation: We recommend the Organization enhance its procedures to ensure that all required documentation used in the determination of sliding fee discounts is consistently collected and retained in each patient's file. We also recommend the Organization consistently apply the policies used to determine sliding fee discounts. View of Responsible Officials and Planned Corrective Action: See corrective action plan.