Finding Text
Health Center Program Cluster; Federal Assistance Listing No. 93.224 and 93.527; HHS; grant
number H80CS08782; budget period May 1, 2023 to April 30, 2024.
Criteria or specific requirement: Special Tests and Provisions – 42 CFR, Part 56.303(e), (f) and
(g). Health Centers receiving funds under the Health Center Program Cluster are required to
prepare a schedule of fees or payments for the provision of its services designed to cover its
reasonable costs of operation and a corresponding schedule of discounts adjusted on the basis
of the patient’s ability to pay, to make every reasonable effort, including the establishment of
systems for eligibility determination, billing and collection, and to secure from patient payments
for services in accordance with the schedule of fees and discounts.
Condition: We noted the Health Center did not properly apply the sliding fee discounts approved
by the board of directors for 3 patients, and 2 patients did not have a sliding fee application on
file, out of a sample of 25 patients tested for the year ended June 30, 2024.
Cause: The Health Center did not comply with its sliding fee policy due to posting errors in the
system and lack of supporting documentation.
Effect or Potential Effect: Discounts were not properly applied to patient accounts.
Questioned costs: None
Context: From a total of 3,983 sliding fee discounts for the period, 25 discounts were selected for
testing. This sample was not, and was not intended to be, a statistically valid sample. The Health
Center’s management did prepare a schedule of discounts adjusted on the basis of the patient’s
ability to pay; such schedule was updated and approved annually by the Health Center’s board
of directors. However, there were errors when comparing the approved schedule to certain
actual adjustments to patients accounts and the patients supporting documentation during the
year ended June 30, 2024 or there was no sliding fee application located for the patient.
Identification as a repeat finding, if applicable: Not a repeat finding.
Recommendation: All personnel involved in the sliding fee discount program should demonstrate
their understanding of the sliding fee scale policy and receive appropriate training during the
year. We also recommend internal review of patient accounts and sliding fees applied during the
year.
Views of responsible officials and planned corrective actions. The Health Center agrees with the
finding. See separate report for planned corrective action.