Finding 1238717 (2025-003)

Criteria – Section 330(k)(3)(G) of the Public Health Service Act and applicable Health Center Program requirements require health centers to maintain a sliding fee discount program under which patient charges are adjusted based on ability to pay. The Health Center Program Compliance Manual, Chapter 9 – Sliding Fee Discount Program, requires the Organization to maintain board-approved policies and an approved sliding fee discount schedule that is applied consistently based on patient income and family size. For patients with annual income at or below 100% of the applicable Federal Poverty Guidelines, the Organization must provide a full discount or, if established by the Organization, charge only a qualifying nominal amount. Patients with income above 100% and at or below 200% of the Federal Poverty Guidelines must receive partial discounts based on gradations in income and the Organization's approved sliding fee discount schedule. Condition and Description – During our testing of the Organization’s Sliding Fee Discount Program, we tested 15 patient encounters and identified two exceptions in which patient charges and related sliding fee adjustments were not applied in accordance with the Organization’s approved sliding fee discount schedule. These exceptions indicate that controls over the consistent application and calculation of sliding fee discounts were not operating effectively during the year. Cause/Effect –. The Organization's procedures were not sufficiently effective to ensure that patient charges and related sliding fee adjustments were consistently calculated and applied in accordance with the approved sliding fee discount schedule. As a result, certain patients were charged amounts that did not conform to the Organization's approved schedule, increasing the risk of noncompliance with Health Center Program requirements and inconsistent application of discounts to eligible patients.