Audit 402895

Health Center Program Cluster – Assistance Listing Number 93.224 U.S. Department of Health and Human Services Award No. 6 H80CS04286‐20, April 1, 2024 – March 31, 2025 Award No. 6 H80CS04286‐21, April 1, 2025 – March 31, 2026 Award No. 1 H8NCS53950‐01, September 1, 2024 – August 31, 2025 Award No. 4 H8JCS54721‐01, December 1, 2024 – November 30, 2025 Criteria or Specific Requirement – Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(G); 42 CFR sections 51c.303(g); and 42 CFR sections 56.303 (f)) Condition – Sliding fee discounts applied to patient charges were inconsistent with the Organization’s sliding fee discount schedule. Cause – The Organization did not comply with its sliding fee discount policy. Effect or Potential Effect – The patients’ responsibility for services rendered by the Organization was inconsistent with the sliding fee discount schedules. Questioned costs – None Context – The population of sliding fee discounts was stratified between (1) in-house pharmacy dispensing fees and (2) all other in-scope services of the Organization. For in-house pharmacy services, a sample of 25 prescriptions was tested from a population of approximately 139,000 prescriptions dispensed through the Organization’s pharmacies, and 5 instances of inappropriate sliding fee discounts were identified. For all other in-scope services, a sample of 25 patient encounters was tested from a population of approximately 123,000 encounters, and 6 instances of inappropriate sliding fee discounts were identified. The sampling methodology employed was non-statistical and was not intended to be statistically valid. Identification as a Repeat Finding, if Applicable – Yes, see 2024-001. Recommendation – The Organization should continue educating personnel on the sliding fee discount program and consider implementing internal audits of sliding fee discounts to monitor and identify specific areas for further improvements or training. When causes to exceptions are identified, the Organization should consider retroactive corrections to remedy noncompliance.