Finding Text
Federal Assistance Listing Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS28372-10-01 Program Year 2024 Criteria or Specific Requirement – Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR sections 51c.303(g) and 42 CFR section 56.303(f)) Condition – Patients received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization’s policy. Cause –The Organization did not comply with their sliding fee discount policy. Effect or potential effect – Sliding fee discounts were given to patients that were inconsistent with the Organization’s sliding fee policy. Questioned costs – None Context – A sample of 40 patient encounters was tested out of the population of 8,900 patient encounters. The sample is not, and is not intended to be, statistically valid. Of the 40 patient encounters tested, two were determined to have resulted in an improper sliding fee adjustment based on the Organization’s policy and screening of patient eligibility. Identification as a repeat finding – Repeat finding, see prior year finding number 2023-004. Recommendation – Management should ensure that sliding fee adjustments are properly applied in accordance with the sliding fee policy and patient eligibility.