Finding Text
Health Center Program Cluster; CFDA No. 93.224 and 93.527; HHS; grant number H80CS28961; budget periods June 1, 2023, through May 31, 2024 and June 1, 2024 through May 31, 2025 Criteria or specific requirement: Special Tests and Provisions – 42 CFR, Part 56.303(e), (f), and (g). Health Centers receiving funds under the Health Center Program Cluster are required to prepare a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts adjusted on the basis of the patient’s ability to pay, to make every reasonable effort, including the establishment of systems for eligibility determination, billing and collection, and to secure from patient payments for services in accordance with the schedule of fees and discounts. Condition: We noted during our testing of compliance with federal awards that the Health Center did not properly apply the sliding fee discounts approved by the board of directors for 3 patients out of a sample of 14 patients for the year ended December 31, 2024. Cause: Errors occurred when analyzing the patient accounts and the incorrect discount occurred based on the Health Center’s policy. Effect or Potential Effect: Discounts were not properly applied to patient accounts. Questioned cost: None Context: From a total of 137 sliding fee discounts for the period, 14 discounts were selected for testing. This sample was not, and was not intended to be, a statistically valid sample. The Health Center’s management did prepare a schedule of discounts adjusted on the basis of the patient’s ability to pay; such schedule was periodically updated and approved by the Health Center’s board of directors and the schedule was uploaded into the Health Center’s billing system. However, there were errors when comparing the approved schedule to certain actual adjustments to patient accounts during the year ended December 31, 2024. For 3 of the 14 accounts selected for testing, the account had an incorrect discount applied. Identification as a repeat finding, if applicable: Not a repeat finding. Recommendation: We recommend management work with the billing team and staff to provide additional trainings for those billers applying the slide to patient accounts and conduct additional internal reviews to verify the patient accounts have been adjusted properly. Views of responsible officials and planned corrective actions: The Health Center will review all applicable policies and ensure that all personnel responsible for and involved in the sliding fee discount program adequately demonstrate their understanding of the sliding fee discount application program. Management will conduct internal reviews periodically throughout the year to verify patient accounts have been adjusted properly.