Finding Text
Finding: 2024-005 Sliding Fee Discounts
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. - 93.224 and 93.527
Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303
Condition: Health centers that receive funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by eligible patients are discounted based on the patient’s ability to pay. During compliance testing, it was determined that the Organization did not obtain and properly document all necessary elements required by the Organization’s policy and that incorrect sliding fee discounts were applied to certain patient accounts.
Cause: There were deficiencies in internal controls over the Organization’s sliding fee program. For certain patient accounts that were tested as part of the audit, the Organization was unable to substantiate that proper documentation was obtained and that proper sliding fee discounts were applied to patient accounts in accordance with the Organization’s sliding fee scale and that incorrect sliding fee discounts were applied to certain patient accounts.
Effect: Proper documentation was unavailable to substantiate that discounts were properly applied to patient accounts, and incorrect discounts were applied to certain patient accounts.
Questioned Costs: None
Context/Sampling: For 6 of 48 patients selected for testing, incorrect discounts were provided. Four patients selected received an incorrect discount, and two patients received a discount who did not qualify for a discount. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue.
Repeat Finding from Prior Year: Yes
Recommendation: It is recommended that employees are properly trained to document and apply the sliding fee discounts in accordance with the Organization’s sliding fee policy. It is also recommended that sliding fee discounts are reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale.
Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above.
Contact Person: Dondre Wilson, CFO
Anticipated Date of Completion: July 31, 2025