Finding Text
Special Tests and Provisions Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Center Program Cluster Assistance Listing Numbers: 93.224 Federal Award Identification Number and Year: H80CS00034-23; H80CS00034-24 Award Period: February 1, 2024 – January 31, 2025; February 1, 2025 – January 31, 2026 Criteria or specific requirement: 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. (42 USC 254b(k)(3)(G); 42 CFR sections 51c.303(f), and (g); and 42 CFR sections 56.303(f), and (g)). Condition: Sliding fee discounts were applied to patient encounters with insufficient documentation being obtained or maintained related to patient family size and income. In these instances, the Organization provided a sliding fee discount despite not having documentation to support the discount applied. Questioned costs: None. Context: Ten (10) of sixty (60) encounters received a sliding fee adjustment without a completed patient application with family size and income. For 8 of these 10 instances, the Organization obtained a completed application and supporting documents for a visit subsequent to the visit selected for testing. Cause: Oversight. Effect: Patient may receive a discount when not eligible or may receive a discount for the wrong amount. Repeat Finding: Yes, prior year finding 2024-001. Recommendation: Management should provide additional training and education to front desk staff related to the process for collecting family size and income information, along with inputting it into the electronic medical records. We also recommend performing and documenting regular internal audits of patient visits to determine whether all required patient information has been obtained in accordance with the Organization's policies. Views of responsible officials: There is no disagreement with this finding.