Finding Text
AL# 93.224 and 93.527 Health Center Cluster - Material weakness in internal control over federal award program - Special Tests and Provisions: Sliding Fee Discounts
Criteria - Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5) and 56.303(f)). The Center should be implementing and monitoring procedures to properly determine, calculate, and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale.
Condition - During audit procedures of sliding fee adjustments there were multiple instances where the slide was inappropriately applied based on the sliding fee discount schedule in place at the time of service and multiple applications were missing.
Questioned Costs - None.
Context- A nonstatistical sample of 25 sliding fee adjustment transactions were selected for testing. Of this sample one error was identified as incorrect sliding fee was given to the patient and five sliding fee applications were missing from the client's records.
Potential Effect - The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended December 31, 2023. In addition, the Center did not comply with its policies and procedures and may have not properly calculated the sliding fee or discount given to the patients and the discount given, in any, may not have been based on the patient's ability to pay.
Cause - The condition is attributable to human error and the lack of internal controls to monitor and review to ensure that the proper sliding fee documentation is being collected and applied.
Recommendation - We recommend the Center provide proper training to employees to ensure that the sliding fee discounts are being properly applied and documented. In addition to implementing policies and procedures to ensure the sliding fee discounts are being properly monitored and supervised on a periodic basis to ensure compliance.
Views of Responsible Officials and Planned Corrective Actions - Management concurs with this finding and will ensure that controls are established to ensure proper training and monitoring of the sliding fee discounts.