Audit 412514

2025-003—Special Tests and Provisions—Sliding Fee Discount Program Federal program information: Funding agency: U.S. Department of Health and Human Services Title: Health Center Cluster Assistance Listing Number (ALN): 93.224 Award number and year: H80CS00202 (1/1/2025 – 12/31/2025) Criteria: According to 42 CFR Part 51c.303(f) and FCCH’s Sliding Fee Discount and Related Billing and Collections Program Policies and Procedures, a community health center must have prepared a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts adjusted on the basis of the patient's ability to pay, provided that such schedule of discounts shall provide for a full discount to individuals and families with annual incomes at or below those set forth in the poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2); and for no discount to individuals and families with annual incomes greater than twice those set forth in such guidelines. Condition: For one of 50 medical claims tested, the sliding fee discount was not applied to the patient’s account at the date of service. FCCH appropriately only collected 20% of the billed amount under the Sliding Fee Discount Program (SFDP) based on the patient’s income level. However, the remaining 80% of the billed amount was not adjusted off the patient account until the claim was tested as part of the audit. Questioned Costs: None Context: One of 50 medical claims tested. Cause: FCCH’s Sliding Fee Discount and Related Billing and Collections Program Policies and Procedures were not followed. Effect: FCCH is not in compliance with 42 CFR Part 51c.303(f). Additionally, FCCH is not in compliance with its Sliding Fee Discount and Related Billing and Collections Program Policies and Procedures. Auditor’s Recommendation: FCCH should implement its established policies and procedures which require adherence to the approved schedule of fees for services and discounts. FCCH should also consider performing its own review of medical claims billed to determine the prevalence of these errors.