Audit 401176

Sliding Fee Discount Supporting Documentation - Significant Deficiency 2025-001 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: H80CS00622 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 Center has established policies to administer these discounts, opportunities exist to strengthen controls, particularly in documentation practices. Support documentation used to determine sliding fee discounts is not consistently maintained in every patient file. Cause: Turnover in certain key positions has placed a strain on operational resources. As a result, procedures related to the maintenance of required documentation for sliding fee determinations have not been fully implemented or consistently followed in accordance with the Center's established policies. Effect: Without proper documentation, there is a risk that patients may receive incorrect sliding fee discounts, potentially resulting in overpayment for services. Recommendation: We recommend the Center 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. View of Responsible Officials and Planned Corrective Action See corrective action plan.