Finding 1238439 (2025-002)

Finding No. SA 2025-002 – Inaccurate Application of Sliding Fee Discounts (Significant Deficiency) Federal Assistance Listing Number: 93.224 Federal Program Title: Health Center Program Cluster Federal Agency: U.S. Department of Health and Human Services Award Period: Fiscal year 2025 Program Identification Numbers: H80CS00850 H8N54038 Criteria: Health centers must have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges and designed to cover their reasonable costs of operation. They are also required to have a corresponding schedule of discounts applied and adjusted based on the patient’s ability to pay. The patient’s ability to pay is determined based on the official poverty guidelines, as revised annually by the U.S. Department of Health and Human Services (HHS). The poverty guidelines are issued each year in the Federal Register and HHS maintains a web page that provides the poverty guidelines. Non-grant funds (State, local, and other operational funding and fees, premiums, and third-party reimbursements which the project may reasonably be expected to receive, including any such funds in excess of those originally expected), shall be used as permitted under the law and may be used for such other purposes as are not specifically prohibited under the law if such use furthers the objectives of the project. Condition: WHC has a schedule of fees and has adopted the Sliding Fee Discount Policy. WHC determines the amount of fees to be charged to a patient based on the patient’s income, expenses, and number of dependents in conjunction with the sliding fee schedule. Of the 60 patients selected for testing, we noted that three patients were charged with the incorrect sliding fee amount, which resulted in overcharging the patients by a total of $30. Cause: WHC has identified the root causes of the issue as staff error in assessing the patient’s ability to pay and insufficient training on the sliding fee program requirements, failing to properly link nominal charges to the corresponding coded procedures. Effect: The deficiencies resulted in inaccurate billing and an increased risk of noncompliance with the HRSA sliding fee discount program requirements. Questioned Costs: $30 in net overcharged sliding fee for patients sampled. Repeat Finding Yes, see Summary Schedule of Prior Year Audit Finding (SA 2024-001)