Audit 411164

Finding 2025.001 Special Tests and Provisions - Significant Deficiency Name of Federal Agency: US Department of Health and Human Services Federal Program Names: Health Center Program Cluster/Health Center Program Federal Assistance Listing Numbers: 93.224 Federal Award Identification Number and Year: H8000166-2025; H8K49695-2024 Criteria Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5),56.108(b)(5) and 56.303(f)). The Center should be implementing and monitoring procedures to properly determine, calculate and review slide fee discounts issued to patients in accordance with the Center's sliding fee scale. Condition The Center did not always calculate the proper sliding fee discount based on the Center's approved sliding fee discount policy. Cause The Center did not have adequate internal controls in place to effectively ensure that the patient received the correct sliding fee discount based on the Center's approved sliding fee discount policy. Effect or Potential Effect The Center did not comply with the appropriate Special Tests and Provisions rules and regulations as per the Uniform Guidance in 2025. Questioned Costs None Context A test of 40 slide fee discount transactions was performed and resulted in an instance of one slide fee discount that was not properly calculated. Identification of Repeat Finding Yes - Finding 2024.001. Recommendation The Center should establish a system of internal controls to ensure that all patients receive the correct sliding fee discount. Views of Responsible Officials Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.