Finding 1061148 (2023-001)

Assistance Listing Number (ALN): 93.527 Assistance Listing Program Title: Health Center Program Cluster Federal Agency: Department of Health and Human Services (HHS) Passed Through Entity: Not applicable Federal Award Numbers: L2C42346 H8G48898 Federal Award Year: July 1, 2021 to June 30, 2024 December 1, 2022 to December 31, 2023 Compliance Requirement: Special Tests and Provisions – Sliding Fee Discounts Criteria or Specific Requirements Section N (1) Special Tests and Provisions – Sliding Fee Discounts of Part 4 Agency Program Requirements of the Health Center Program Cluster, states that “Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges and designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted based on the patient’s ability to pay. The patient’s ability to pay is determined based on the official poverty guidelines, as revised annually by the U.S. Department of Health and Human Services (HHS). The poverty guidelines are issued each year in the Federal Register and HHS maintains a web page that provides the poverty guidelines.” Condition The Organization determines the amount of fees to be charged to a patient based on the patient’s income, expenses, and number of dependents in conjunction with the sliding fee schedule. Of the 25 patients selected for testing, we noted two patients who were charged the incorrect sliding fee amount. One patient was overcharged by $3, while the other was undercharged by $40. Questioned Costs None. Causes and Effect The Organization’s staff inadvertently applied the incorrect sliding fee amount due to insufficient training and oversight. As a result, the determination of the patient’s co-pay was not consistent with the sliding fee schedule. Recommendation We recommend that the Organization strengthen its internal control procedures to ensure the accurate determination and application of the sliding fee discounts. Specifically, the Organization should provide additional training to staff involved in the sliding fee process and ensure that appropriate individuals are monitoring and reviewing the Organization’s compliance with the program requirements. This will help ensure that patients are charged the proper sliding fee and that program goals and objectives are met.