Finding Text
Information on Federal Program: U.S. Department of Health and Human Services – Health Center Program Cluster AL# 93.224 Criteria Section 42 USC 254b(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)) requires that health centers provide discounted fees for individuals and families with incomes above 100% and at or below 200% of the federal poverty guidelines. Condition For the year ended January 31, 2026, we requested the supporting documentation for a sample of patient visits with discounted fees under the sliding fee program to support that patients were eligible for the discount and that it was applied in accordance with the Center’s internal policies and procedures. During testing of 40 patient accounts subject to the Sliding Fee Discount Program, we identified 2 instances in which the sliding fee discount was not applied correctly. As a result, the patients were billed amounts that differed from what they should have been charged under the organization's approved sliding fee discount schedule. Cause Internal controls, while designed appropriately, were not implemented consistently to allow for the detection and correction of these types of errors. Effect or potential effect The sliding fee discount program may not be operating in accordance with federal regulations. Questioned costs None noted. Recommendation The entity should revisit their current internal control policies and provide additional training for staff to ensure compliance with documented controls. Additional research should be done into the cause of the incorrectly applied sliding fee discounts to determine if this was a system issue to determine the best course of action. If this is determined to be a manual adjustment done incorrectly, we recommend additional training be provided to staff as well as additional controls to review the manually applied discounts for accuracy. Views of Responsible Officials and Planned Corrective Actions Management will work to ensure that the SFS discount applications are completed accurately and that the SFS discounts are recorded accurately in the system by auditing the SFS applications and verifying the SFS in the system matches the SFS application. In addition, Management will audit a sample of the SFS discounts on a monthly basis to assure the SFS is applied correctly. Management will also provide additional training to staff as needed and provide further guidance on the internal SFS policies and procedures. Indication of Repeat finding This is a repeat finding of finding 2025-003 from the prior year.