Finding 1169208 (2025-002)

Finding 2025.002: Special tests and provisions – Sliding Fee Discounts – Significant Deficiency Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless and Public Housing Primary Care) Grants for New and Expanded Services Under the Health Center Program COVID-19 Grants for New and Expanded Services Under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Federal Award Identification Number and Year: H8000133 - 2025 and 2024, H8L50678 - 2024, H8H46190 - 2023 and 2024 Criteria Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5), 56.108(b)(5) and 56.303(f)). PHC should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with PHC's sliding fee scale. Condition PHC did not always calculate the proper sliding fee discount based on approved policies or have adequate documentation on file. Cause PHC did not have adequate internal controls in place to effectively ensure that patients received the correct sliding fee discount and have adequate documentation on file. Effect or Potential Effect PHC did not comply with the appropriate Special Tests and Provisions rules and regulations as per the Uniform Guidance in 2025. Questioned costs None. Context A test of 40 sliding fee discount transactions was performed and resulted in one instance of an incorrect sliding fee calculation, eight instances of inadequate documentation on file to support the sliding fee calculation and three instances of lack of review and approval. Our sample was a statistically valid sample. Identification of Repeat Finding This finding is a repeat finding (see prior year Finding 2024.001) Recommendation PHC should establish a system of internal controls to ensure that all sliding fee discounts are properly calculated and supported based on family size and income. Views of Responsible Officials Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.