Finding Text
Finding 2024.001: Special Tests and Provisions - Sliding Fee Scale
Documentation - Material Weakness
Grantor: U.S. Department of Health and Human Services
Federal Program Names: Health Center Program Cluster: Health Center
Program (Community Health Centers, Migrant
Health Centers, Health Care for the Homeless, and
Public Housing Primary Care), COVID-19 - Grants
for New and Expanded Services under the Health
Center Program
Federal Assistance Listing Numbers: 93.224 and 93.527
Federal Award Identification Number and Year: H80CS00029 - 2023 and 2024, H2ECS50128 -
2023, H8LCS51483 - 2023, H8GCS48563 - 2023
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),
56.108(b)(5) and 56.303(f)). The Organization should be implementing and monitoring procedures
to properly determine, calculate and review sliding fee discounts issued to patients in accordance
with the Organization's sliding fee scale.
Condition
The Organization did not always have the proper slide fee documentation readily available to
ensure the proper slide fee discount was applied based on approved policies or the discount was
calculated incorrectly.
Cause
The Organization did not have adequate internal controls in place to effectively ensure that all
sliding fee discounts were properly calculated based on approved documentation.
Effect or Potential Effect
The Organization did not comply with the appropriate rules and regulations as per the Uniform
Guidance.
Questioned Costs
None Context
A test of 40 sliding fee discount transactions was performed and resulted in 27 instances where the
Organization was unable to provide approved documentation, or the sliding fee discount was
calculated incorrectly. Our sample was a statistically valid sample.
Identification of Repeat Finding
Yes see prior year Finding 2023.001
Recommendation
The Organization should establish a system of internal controls to ensure that all sliding fee
discounts are properly calculated and supported based on family size and income.
Views of Responsible Officials and Planned Corrective Actions
Management agrees with the audit finding and will strengthen internal controls and accountability to
correct the deficiency.