Finding Text
Item: 2025-002 Assistance Listing Number: 93.224 Program: Health Center Program Federal Agency: U.S. Department of Health and Human Services Contract Number: 24H80CS28365; H8JCS54690; 21H8HCS44987 Award Year: June 1, 2024 to May 31, 2025; December 1, 2024 to November 30, 2025 September 1, 2023 to August 31, 2025 Compliance Requirement: Special Tests and Provisions Criteria: Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition: For five claims tested, the discount for eligible patients was inaccurately calculated and billed. Questioned Costs: N/A Context: In a population of 7,227 claims, we conducted a non-statistical sample of 40 claims. For five claims tested, we noted the discount for eligible patients was inaccurately calculated and billed. We also noted no evidence of management review or approval of the sliding fee discount applied. Effect: The system of internal controls was not properly implemented to ensure review and approval of the sliding fees discounts applied prior to billing the eligible patients. This is deemed to be a material weaknesses in internal control over compliance. Cause: The Organization does not have a supervisory review process implemented for application of the sliding fee discount. Identification as a Repeat Finding: Not a repeat finding. Recommendation: The Organization should implement additional controls to ensure claims where a sliding fee discount is applied are reviewed and approved prior to billing the patient. This review and approval should be clearly documented. Views of Responsible Officials: Management of the Organization concurs with the finding. See Corrective Action Plan.