Finding Text
Criteria or Specific Requirement
Per Title 42 Chapter 1 Subchapter D Section 51c303(f), “Health centers must have a schedule of fees
or payments for the provision of their health services consistent with locally prevailing rates or charges
designed to cover their reasonable costs of operation. They are also required to have a corresponding
schedule of discounts applied and adjusted on the basis of the patient’s ability to pay.”
Condition and Context
During our testing of 60 sliding fee discounts for health center patients qualifying for reduced charge
visits, we identified two visits where a slide was provided but there was no application on file to support
the slide that was applied and two visits where an incorrect sliding fee was given to a patient based on
their income and family size.
Effect
Potential that a patient would not receive the appropriate sliding fee discount.
Questioned Costs
None identified.
Cause
Clerical error in which the application was not scanned into the patients chart due to lack of an
oversight process in place.
Recommendation
We recommend the Organization to review internal controls in regards to the determination, recording,
and monitoring of the sliding fee process to ensure that appropriate sliding fee rates/categories are
utilized for each sliding fee encounter.Views of Responsible Officials
The Organization made changes to improve the process and procedure based on the 2023 audit
finding, but they were not implemented until mid-year 2024 based on the completion of the audit. It is
expected that 100% improvement in findings would not take place with this late implementation. There
was an improvement over the prior year, especially in the lack of documentation on file. The monthly
audit process to spot check applications for accuracy and ensure complete documentation in the chart
was also implemented mid-year in 2024.