Finding Text
Finding 2026-001: Special Tests and Provisions - Sliding Fees Program Title: Health Center Cluster Assistance Listing Number: 93.224 Federal Award Year: February 1, 2025 to January 31, 2026 Federal Agency: U.S. Department of Health and Human Services 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 Wipfli LLP tested 40 sliding fee transactions to verify if the amount charged was calculated properly based on the patient's income level and in compliance with Milwaukee Health Services, Inc.’s sliding fee policy. Wipfli LLP noted that for four (4) of the sampled transactions that the sliding fee category was properly determined but amounts charged for services were incorrectly applied resulting in the guarantors being improperly over or undercharged for services. The four transactions identified as exceptions consisted of services provided to and amounts due from two (2) guarantors. Questioned Costs Undetermined. Cause and Effect Milwaukee Health Services, Inc.'s electronic health record platform and practice management system automatically determines a guarantor's sliding fee category based on information entered by in-take staff and applies the sliding fee discount when encounters are entered into the system. Subsequent changes to the sliding fee category determination require staff of Milwaukee Health Services, Inc. to manually update amounts charged for existing encounters within the system. Milwaukee Health Services, Inc. failed to manually update the sliding fee discount applied for the four sampled transactions noted. As a result, guarantors may be charged the improper amount if proper procedures and controls are not in place to ensure the sliding fee is applied in accordance with Milwaukee Health Services, Inc.’s sliding fee policy. Auditor’s Recommendation Review policies and implement and monitor controls surrounding the determination of the fees charged to guarantors when adjustments are made to the guarantor's sliding fee category determination. View of Responsible Officials Management agrees with the findings and has committed to a corrective action plan.