Finding 1151076 (2025-001)

U.S. Department of Health and Human Services Assistance Listing Number 93.224 and 93.527 Health Center Program Cluster Program Year 2024-2025 Criteria or Specific Requirement – Special Tests and Provisions: Sliding Fee Discounts Condition – Patients did not receive the proper sliding fee adjustments under the Organization’s policy. Cause – The Organization did not comply with its sliding fee policy. Effect or Potential Effect – Incorrect sliding fee discounts were given in the sample selected for testing. Questioned Costs – None Context – A sample of 40 patients was tested out of the total population of 8,457 encounters. Seven patients did not receive the proper sliding fee adjustments. The sampling methodology used is not and is not intended to be statistically valid. Identification as a Repeat Finding – Yes Recommendation – We recommend management ensures all personnel understand the sliding fee scale policy and adhere to the requirements and guidelines set forth in the policy. Procedures should be implemented to ensure eligible patients receive discounts in accordance with the sliding fee scale. Views of Responsible Officials and Planned Corrective Actions – The Organization concurs with the finding and management has continued to implement procedures to ensure eligible patients receive discounts in accordance with the sliding fee scale. The Office Managers have continued reviewing all new sliding fee applications on a monthly basis to ensure accuracy. The Billing Manager has continued to conduct quarterly audits of sliding fee claims to ensure the adjustments are entered correctly by the billing department. The Organization has also launched additional training for all individuals involved in the sliding fee application process as well as automated sliding fee adjustments to reduce errors.