Finding Text
Criteria: This award requires that health centers provide sliding fee discounts for services provided based on the patient’s ability to pay, in accordance with the Center’s sliding fee policy. The patient’s ability to pay is based on the type of services provided, patient’s annual income, and household size, in accordance with the Center’s sliding fee policy. Condition and Context: During our audit of a sample of 40 patients who received sliding fee adjustments, we noted the following: • For 4 of 40 patients tested, the fee charged for the service(s) provided did not agree to the fee schedule. It is further noted that this would not have had any bearing on the correct slide being charged. However, charging an incorrect fee could lead to an incorrect amount being written off as a sliding fee adjustment. • For 1 of 40 patients tested, documentation noted that the patient originally self-declared no income but then was seen for multiple visits thereafter with no income verification. Ultimately no slide was applied and the entire balance was written off. Per the Center’s policy, a patient may only self-declare income once. Future visits should have required income verification to determine the proper discount to apply. • For 1 of 40 patients tested, the income support provided supports a higher annual income than what was calculated on the application. As a result, the patient should not have qualified for a sliding fee discount based on the behavioral health sliding fee scale. While the correct sliding fee discount was charged based on the annual income as noted on the application, the error in annual income calculation did not support the patient being eligible for any sliding fee discount. Effect: While there are no material questioned costs associated with these findings, the effect of the breakdown in internal controls over the sliding fee application process allows for potential noncompliance related to the use of federal funds. Cause: The cause of these findings was due to insufficient review and oversight of the sliding fee application process. Recommendation: We recommend the entity strengthen its internal controls over the sliding fee application and administration process, to include further training of individuals with responsibility for approving sliding fee applications, and enhanced oversight by an independent person to ensure the correct fees are charged for services provided, and the income verification supports the correct sliding fee discount based on the sliding fee scales in effect at time of service. We further recommend enhancements to internal controls to ensure that patients who self-declare no income are providing income verification at subsequent visits.