Finding Text
Information on the federal program – Assistance Listing Number 93.224/93.527, Health Center Program Cluster from the U.S. Department of Health and Human Services, Federal Award No. 6
H80CS00196 for project period January 1, 2023 through December 31, 2025.
Criteria or specific requirement – Health centers must prepare and apply a sliding fee discount schedule that incorporates the provisions of 42 CFR 51c.303e through 56.303g to ensure that
amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay.
Condition – The audit of the major federal program identified errors in the application of sliding fee adjustments.
Cause – The sliding fee calculation was improperly set up within the Electronic Health Record System.
Effect or potential effect – Inaccurate application of sliding fee adjustments may result in potential noncompliance with program requirements.
Questioned costs – Not applicable
Context – Out of a population of 1,478 sliding fee adjustments, a sample of 25 adjustments were tested. Out of the 25 tested, 6 adjustments were incorrectly calculated based on the Organization’s approved sliding fee scales and the patient’s sliding fee application. A non-statistical sampling methodology was used to select the sample.
Identification as a repeat finding – Is a repeat finding (see 2023-001)
Recommendation – We recommend that the Organization perform a review of the calculation of the sliding fee adjustments within the Electronic Health Record system to ensure it is properly set up.
Additionally, we recommend that a member of management with an understanding of the Organization’s billing and sliding fee policies regularly review a sample of sliding fee adjustments in comparison to the Organization’s sliding fee policy.
Views of responsible officials and planned corrective actions – See separate auditee document for planned corrective action.