Finding Text
Finding No. 2024-001: Special Tests and Provision - Sliding Fee Scale Discounts
Program Affected: Direct Award - Department of Health and Human Services: Health Center Program Cluster (Health Center Program AL No. 93.224). Grant No. H80CS00517, with grant periods July 1, 2023 through February 28, 2024, and March 1, 2024 through June 30, 2024.
Questioned Costs: None
Condition: The Clinic’s sliding fee scale policy provides for the application of discounts to eligible patients based on the ability to pay. The Clinic has designed an internal control to provide a review and approval of eligibility determinations within the established sliding fee scale based on income and family size. During our testing of participants, it was noted that one out of the 40 individuals sampled and tested was billed incorrectly. The individual was billed more than they should have been based on the determined sliding fee scale level.
Criteria: 42 CFR Sections 51c.303(e), (f), and (g) require a health center to apply sliding fee discounts to patients consistent with its sliding fee discount schedule. The Uniform Guidance requires grantees to design and implement internal controls over compliance to prevent, or detect and correct noncompliance with compliance requirements.
Cause: The Clinic’s billing review process did not appropriately detect the billing error in assigning the sliding fee scale discount for the individual.
Effect: The internal control did not operate effectively, and that failure resulted in an individual being billed incorrectly.
Recommendation: Wipfli LLP recommends the Clinic to review its internal process for reviewing and approving bills before they are sent to patients.
Views of responsible officials: We agree with the finding and have had already implemented corrective action during the current fiscal year.