Finding Text
Condition: The Council lacked adequate controls over its sliding fee discount program to ensure applications were properly processed, recorded, and received the correct discount. For three of the 40 patient files reviewed who received a sliding fee discount, patient information was inadequate to determine the proper sliding fee discount or the patient was given incorrect discounts based on information provided. Criteria: Health centers must prepare and apply a sliding fee discount schedule and policy so that the amounts owed for health center services by eligible patients are adjusted based on the patient’s ability to pay (42 USC 254(k)(3)€, (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)). Cause: The Council did not always follow the review process in place to verify that eligible patients received the applicable sliding fee discount according to the Council’s policy. Effect: The Council’s SFS patients’ services were not properly discounted; therefore, those patients were not charged the correct discounted fee in accordance with federal requirements. Recommendation: It is recommended to develop proper controls around the collection of sliding fee applications, verifying required patient information is present and complete, and apply the sliding fee discount in accordance with written policies. This will ensure the Council can detect and prevent ineligible patients from receiving the discount and comply with federal compliance requirements. In order to ensure that SFS discounts are properly calculated and documented, the Council should increase the frequency of random reviews of its SFS applications in order to help detect and correct errors or incomplete applications on a timely basis. View of responsible officials: Management acknowledges this condition related to lack of adequate controls over the sliding fee discount program and is creating controls that will assure compliance with requirements.