Finding Text
Information on the Federal Program - Assistance Listing Number 93.224, Health Center Program Cluster from the U.S. Department of Health and Human Services, Federal Award No. 6 H80CS22681 for project periods June 1, 2023 through May 31, 2025. Criteria or Specific Requirement - Health centers must prepare and apply a sliding fee discount schedule that incorporates the provisions of 42 CFR 51c.3032 through 56.303g to ensure that amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition – During our review of the Organization’s sliding fee calculations, we noted 5 patient encounters with incorrectly calculated sliding fee adjustments. We also noted improper write-off adjustments coded as sliding fee adjustments. Cause - Various adjustments, including the sliding fee, were not applied appropriately due to incorrect inputs in the Organization’s system. Effect or Potential Effect - The sliding fee adjustments were not appropriately applied. Questioned costs - Not applicable Context - Out of a population of 596 sliding fee adjustments, a sample of 25 adjustments was tested. Out of the 25 tested, all the selections included a write-off adjustment that was inappropriately coded as a sliding fee adjustment. Additionally, 5 adjustments were incorrectly calculated based on the Health Center’s approved sliding fee scales and the patient’s sliding fee application. A nonstatistical sampling methodology was used to select the sample. Identification as a Repeat Finding - Is a repeat finding (2024-002). Recommendation - We recommend that the Organization implement a review process for sliding fee and other adjustments applied in the billing system, including review for the sliding fee application and relating supporting documents. Additionally, we recommend that a member of management with an understanding of the Organization’s billing and sliding fee policies regularly review a sample of sliding fee adjustments in comparison to the Organization’s sliding fee policy. Views of Responsible Officials and Planned Corrective Actions – Management has already begun to implement corrective actions to strengthen compliance with HRSA Sliding Fee Discount Program requirements. Corrective measures include updating sliding fee procedures, annual staff training, monthly quality assurance reviews, and ongoing management oversight of sliding fee adjustments and supporting documentation.