Finding 2025.002 - Special Tests and Provisions - Sliding Fee Scale Documentation Recommendation The Center 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. Action Taken This was also a finding in the 2023 Audit and again in 2024. In response to the audit finding, I worked directly with the Director of Clinical Operations and the Patient Service Representative Manager to conduct a comprehensive review of the health center's existing sliding fee scale policy to ensure alignment with federal guidelines and best practices, including clarification of documentation requirements, acceptable forms of income verification, and the definition of family size. We developed and implemented a step-by-step standard operating procedure (SOP) for Patient Service Representative (PSR) staff to consistently assess and apply sliding fee discounts. The SOP includes clear instructions for verifying documentation, calculating discount eligibility, and recording determinations in the patient's record. The Clinical Operations Director's management team will conduct quarterly spot audits of a sample of sliding fee files to verify correct application and documentation. The managers will report the findings to leadership, provide corrective follow-up, and provide any needed training for PSR personnel on the updated policy and procedures. I reported all identified and assessed changes to the health center's board of directors or its audit committee for review and oversight. The board verified that appropriate corrective action was being taken regarding internal controls. Waikiki Health is also considering engaging an outside firm to assist with streamlining the sliding fee scale process and strengthening related internal controls.