Audit 407868

Material Weakness Finding: 2026-001 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster Assistance Listing No. 93.224 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by eligible patients are discounted based on the patient’s ability to pay. During compliance, testing the following errors were noted: • Certain patients received discounts that were calculated incorrectly • Sliding fee applications were not available for certain patients who received discounts Cause: There were deficiencies in internal controls designed to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization’s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to certain patients. In addition, sliding fee applications were not available in some cases, as required by the Organization’s policies. Effect: Discounts were not properly applied to patient accounts and patients received discounts without a complete sliding fee application. Questioned Costs: None reported. Context/Sampling: For 5 of 20 self-pay patients selected for testing, discounts were not appropriately applied. For 2 of 20 patients selected, sliding fee applications were not available. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate and that proper documentation is obtained. In addition, it is recommended that supervisory level personnel select and review a sample of sliding fee applications and discounts to ensure that discounts are properly applied by staff, and that all required documentation is retained. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Sandra Gillard, CEO Anticipated Date of Completion: August 31, 2026