Finding 1166285 (2023-002)

Health Center Program Cluster – Assistance Listing Numbers 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 5 H80CS04226-18-00 Program Year 2023 Criteria or Specific Requirement – Special Tests and Provisions: Sliding Fee Discounts – 42 CFR 245(k)(3)(g); 42 CFR section 51c.303(g) and 42 CFR section 56.303(f). Condition – Patients who were eligible for sliding fee discounts under the Organization’s policy were not given sliding fee discounts or received sliding fee discounts inconsistent with the policy. Cause – The Organization did not comply with their sliding fee discount policy. Effect or potential effect – Improper sliding fee discounts were given and appropriate documentation was not maintained for all sliding fee discounts given. Questioned costs – None Context – A sample of 40 patients were tested out of the total population of 50,510 encounters. The sampling methodology used was not, and was not intended to be, statistically valid. Of the 40 transactions tested, 4 were determined to include errors in the application of the sliding fee discount program and policy. Identification as a repeat finding – Repeat finding of finding 2022-003 Recommendation – The Organization should continue to ensure 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 that eligible patients receive discounts in accordance with the sliding fee scale. Patient files should include documentation of eligibility to receive sliding fee scale discounts.