Finding 1237670 (2025-002)

MATERIAL WEAKNESS Federal Agency: U.S. Department of Health and Human Services Assistance Listing Number: 93.224 Repeat Finding: Repeat finding of 2024-002. 2025-002: Improper Administration of the Sliding Fee Program Compliance Requirement: Special Tests and Provisions Criteria – The Health Center should apply its sliding fee scale to qualifying individuals based on patient income and family size. Condition and Context – Based on the 40 patients selected for Single Audit compliance testing, we noted 6 errors. The errors consisted of incorrect discounts being applied to certain patient accounts, and patients not being consistently evaluated for sliding fee discounts based on patient income and family size. Cause – The deficiency resulted from errors in applying the effective sliding fee discount schedule using each patient’s verified income and household size. In addition, the Health Center did not consistently obtain the patient income and family size information necessary to evaluate eligibility and determine the appropriate discount. Effect – As a result, improper sliding fee discounts were applied to various patient accounts, including discounts that were not consistent with the effective sliding fee discount schedule. Recommendation – We recommend that the Health Center review procedures to ensure that: 1. Required patient income and family size information is obtained and documented 2. Patients are evaluated for sliding fee discount eligibility based on that information 3. Sliding fee discounts are accurately calculated, applied, and posted to patient accounts for eligible encounters in accordance with the effective sliding fee discount schedule. Management’s Response – We recognize the needs for proper internal control processes and procedures to ensure that sliding fee discounts are properly applied and posted to patient accounts for eligible encounters and that patients are evaluated for eligibility for sliding fee discounts.