Finding Text
Material Weakness Finding: 2025-001 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster Assistance Listing No. - 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health centers that receive funding under the Health Center Program Cluster are required to document sliding fee discounts in accordance with the Organization’s policies. During compliance testing, it was determined that the Organization did not maintain proper documentation of all necessary elements of sliding fee discounts as required by the policy. This was a result of sliding fee applications being incomplete, expired, or missing. One patient did not receive a discount when the patient qualified for a discount based on the Organization’s policies. In addition, the Organization’s sliding fee policy does not address one-day self-certification for patients who have no income support documentation. Cause: There were deficiencies in internal controls over the Organization’s sliding fee program. For certain patient accounts that were tested as part of the audit, the Organization was unable to substantiate that proper documentation was obtained from the patients, and that the resulting sliding fee discounts were correctly calculated and applied in accordance with the Organization’s sliding fee policy. Effect: Documentation to substantiate discounts applied to certain patient accounts was not available for certain sliding fee patient visits during the year. One patient who qualified to receive a discount did not receive a discount. Questioned Costs: None Context/Sampling: For 12 of 48 patients selected for testing, sliding fee applications were incomplete, missing, or expired. For 1 of 48 patients selected for testing, the patient did not receive a discount when the patient qualified for a discount based on the Organization’s sliding fee policies. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that employees be trained to maintain the required documentation, for sliding fee discounts provided. It is also recommended that patient records are reviewed by a supervisor, on a periodic basis, to ensure that the required documentation is properly maintained and that patients who qualify for a discount receive the appropriate discount. It is also recommended that the Organization update its sliding fee policy to address self-certification for patients who have no income support documentation. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Mark Rajkowski, CEO Anticipated Date of Completion: October 31, 2025