Finding Text
Federal Assistance Listing Nos. 93.224 and 93.527
U.S. Department of Health and Human Services
Award No. 5 H80CS28372-09-00
Program Year 2023
Criteria or Specific Requirement – Special Tests and Provisions:
Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g) and 42 CFR section 56.303(f))
Condition – Patients received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization’s policy.
Cause –The Organization did not comply with their sliding fee discount policy.
Effect – Sliding fee discounts were given to patients that were inconsistent with the Organization’s sliding fee policy.
Context – A sample of 25 patient encounters was tested out of the population of 8,900 patient encounters. The sample is not, and is not intended to be, statistically valid. Of the 25 patient encounters tested, three were determined to have resulted in an improper sliding fee adjustment based on the Organization’s policy and screening of patient eligibility.
Identification as a repeat finding – Not a repeat finding
Recommendation – Management should ensure that sliding fee adjustments are properly applied in accordance with the sliding fee policy and patient
eligibility.