Finding Text
2024 – 003: Significant Deficiency – Sliding Fee Discount Program
Information on Federal Program:
U.S. Department of Health and Human Services – Health Center Program Cluster
AL# 93.224 and 93.527
Criteria – Section 42 USC 254b(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g);
and 42 CFR sections 56.303(e), (f), and (g)) requires that health centers provide discounted
fees for individuals and families with incomes above 100% and at or below 200% of the federal
poverty guidelines.
Condition – For the year ended January 31, 2024, we requested the supporting documentation
for a sample of patient visits with discounted fees under the sliding fee program to support that
patients were eligible for the discount and that it was applied in accordance with the Center’s
internal policies and procedures. In a sample of 40 patient visits, we noted two patient visits
where discounted fees were applied incorrectly and one where the SFS audit form wasn’t
completed correctly.
Cause – Internal controls, while designed appropriately, were not implemented consistently to
allow for the detection and correction of these types of errors.
Effect or potential effect – The sliding fee discount program may not be operating in accordance
with federal regulations causing a potential loss of funding.
Questioned costs – None noted.
Context – One patient visit had the sliding fee discount applied to their account at a higher level
than what they qualified for based on their income and family size. One patient had sliding fee
discounts applied to their charges after their previous application had expired and another
application was not completed. One patient’s SFS audit form was completed incorrectly not
supporting the SFS calculation in the file.
Repeat finding – This is a new finding.
Recommendation – The entity should revisit their current internal control policies and provide
additional training for staff to ensure compliance with documented controls. Additional research
should be done into the cause of the incorrectly applied sliding fee discounts to determine if this
was a system issue to determine the best course of action. If this is determined to be a manual
adjustment done incorrectly, we recommend additional training be provided to staff as well as
additional controls to review the manually applied discounts for accuracy.