Finding Text
Ineffective Controls Over the Sliding Fee Scale Eligibility Requirements
Federal Agency: Department of Health and Human Service
Federal Program: Health Center Program
Assistance Listing Number: 93:224/93.527
Type of Finding: Significant Deficiency
Condition
Community Health Concern, Inc. (“CHC”) did not effectively maintain an internal control system over its
sliding fee and clinic service eligibility requirements. During the compliance testing of the Uniform Guidance
“Special Tests and Provisions – Sliding Fee Applications” requirements, we noted:
• Two (2) patient files/charts did not have the required eligibility information, including sliding fee
scale assessments, proof of income, general consent, registration form, etc.
• A Medicare patient was assessed a sliding fee scale discount for services that should have been
charged to Medicare.
Possible Asserted Criteria:
Per the Uniform Guidance, health centers must prepare and apply a sliding fee discount schedule (SFDS) so
that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the
patient’s ability to pay.
Possible Asserted Cause:
Staff’s inability to fully grasp the new medical health system, EPIC is contributing to the internal controls
ineffectiveness over the sliding fee scale application and the patient encounter process.
Potential Asserted Effect of Condition:
Lack of effective internal control procedures could result in unintentional errors that may not be detected in a
timely manner by employees in the normal course of performing their assigned duties.
Questioned Costs:
N/A.
Recommendation:
Management should undergo additional training of its EPIC system to help mitigate potential patient
encounter errors. Additionally, a system of quality control should be implemented to allow periodic
assessment and transactions reviewed of patient’s encounter and charts to ensure the process is functioning
properly.
Management’s Views:
Management’s response is included in the “Management’s Views and Corrective Action Plan” included at the end of
this report after “Section IV – Status of Financial Statements Findings of Prior Audits.”