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
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: Patients eligible for a sliding fee discount received a discount without documentation
supporting eligibility and qualification for reduced charges.
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, where supporting documentation to
determine the appropriate sliding fee discount was not retained. We did not proceed with testing after
instances were identified.
Cause: Supporting documentation, approved patient application for sliding fee discount, was not
retained to verify patient’s eligibility per the health center’s policies and procedures.
Effect: Patients not eligible for the sliding fee discount would receive a sliding fee discount or patients
approved for a sliding fee discount would receive an incorrect discount.
Recommendation: We recommend implementation of a second level independent review over the
demographic data and income verification information entered into the patient billing system in order to
ensure the financial documents are retained.
Views of responsible officials: There is no disagreement with the audit finding.