Audit 415525

Criteria Recipients of Health Center funding are required to maintain and document eligibility determinations for patients receiving services under the Sliding Fee Discount Program. Eligibility determinations should be supported by appropriate documentation, including household size, family composition, income verification, and evidence of review and approval in accordance with the health center's policies and federal requirements. Context During the audit period, the Corporation experienced significant turnover within key operational and administrative positions responsible for overseeing the Sliding Fee Discount Program. In addition no individual had been assigned primary responsibility for oversight and monitoring of compliance with Sliding Fee Discount Program requirements. Condition During our testing of 25 patient files, we noted 8 exceptions where supporting documentation used to determine Sliding Fee Discount Program eligibility was incomplete or not maintained. Exceptions included missing documentation related to household size, family members, income verification, and evidence supporting the discount level granted. Cause Management's review controls over the eligibility determination process were not operating effectively to ensure all required documentation was obtained, retained, and reviewed prior to approval of Sliding Fee Discount Program benefits. Effect Incomplete or unsupported eligibility determinations increase the risk that patients may receive discounts that are not supported by appropriate documentation and may result in noncompliance with Health Center Program requirements. Recommendation We recommend management strengthen controls over the Sliding Fee Discount Program eligibility process by implementing standardized documentation requirements, supervisory review procedures, and periodic monitoring to ensure that all required documentation is obtained, appropriately retained, and supports the eligibility determination and discount level awarded.