Finding Text
Federal Agency: U.S Department of Health and Human Services
Federal Program Name: Health Center Program Cluster
Assistance Listing Number: 93.224 and 93.527
Award Period: 1/1/2024 – 12/31/2024
Type of Finding: Significant Deficiency in Internal Control over Compliance and Compliance
Criteria or specific requirement: Under the compliance requirement for Special Tests and Provisions
for ALN 93.224-93.527, “health centers must prepare and apply a sliding fee discount schedule (SFDS)
so that the amounts owed for health center services by eligible patients are adjusted (discounted)
based on the patient’s ability to pay”.
Condition: Encounters eligible for a sliding fee adjustment did not receive the appropriate adjustment
per the patient’s approved sliding fee discount level.
Context: During our testing of sliding fee discounts for health center patients qualifying for reduced
charge visits, we identified three visits in a sample of forty, which received the incorrect sliding fee
discount. We did not proceed with testing after instances were identified.
Cause: Internal control process and procedures were not followed resulting in a discount applied in the
billing system that did not match the sliding fee determination per the approved patient application.
Effect: Patient would receive an incorrect sliding fee discount.
Recommendation: We recommend implementation of a second level independent review of the
demographic data and income verification information entered into the patient billing system in order to
ensure the financial classification is correct.
Views of responsible officials: There is no disagreement with the audit finding.