Finding Text
Sliding Fee Scale; AL#: 93.224 and 93.527; Program: Health Center Cluster
Condition: As a result of our audit procedures, we found one error in the application of
the sliding fee scale.
Criteria: The sliding fee scale discount is based on patient income and demographic
information. Controls should be in place to ensure the sliding fee scale is
consistently applied for each patient.
Effect: Continued noncompliance could result in a loss of funding. Additionally, it
could result in inequitable access to healthcare services for patients and
expose the Center to reputational risks.
Context: During our testing, we found 1 of the 40 patients tested were not billed for
the proper slide category based on the sliding fee scale provided by the
Center. No questioned costs were identified.
Cause: The error resulted from a claim with a date of service near the end of the
effective date of the sliding fee scale schedule. The claim was processed after
the new schedule and annual income levels were effective and the improper
schedule was used to apply the sliding fee scale adjustment. Additionally, the
sample size for internal auditing was too small to detect errors. Primary and
secondary review of sliding fee scale applications requires additional training
and resources to ensure errors are detected timely.
Recommendation: We recommend that the Center strengthen its internal controls by regularly
monitoring patient eligibility and reviewing claims without insurance prior to
mailing bills to ensure proper application of the sliding fee scale.
Management Response: See Corrective Action Plan.