Finding Text
Criteria or Specific Requirements
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
The Organization 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 4 patients were charged the incorrect sliding fee amount, which
resulted in the Organization undercharging 4 patients by a total of $60.
Questioned Costs
The total net amount undercharged was $60 for patients sampled.
Cause and Effect
The potential causes for the above errors are as follows:
Error by staff in determining the patient’s ability to pay; and
Lack of training.
As a result, the determination of patient fee amounts charged may not be consistent with the sliding
fee schedule.
The errors for the 4 patients identified above occurred before management’s corrective action was
implemented on April 30, 2023.Recommendation
We recommend that the Organization’s controls and procedures be strengthened to ensure 1) income
declaration is properly verified and adequately documented and 2) the sliding fee discount is properly
determined and applied. The Organization should also provide additional training to staff involved in
the sliding fee process and ensure that appropriate individuals are properly monitoring and reviewing
the Organization’s compliance with program requirements. This will help ensure that the proper sliding
fee is charged to patients and that program goals and objectives are being met.
Views of Responsible Officials and Planned Corrective Actions
The Organization will continue to implement the following measures to ensure compliance with the
sliding fee discount program, and consistently assess patient income and family size.
The Organization will continue to provide ongoing training to clinic staff who evaluate the sliding fee
application at its clinic locations. The training consists of reviewing sliding fee program policies and
procedures along with all applicable patient forms, sliding fee scale, and patient eligibility.
The following quality control measures to ensure compliance have been implemented effective April
30, 2023;
1. Front Desk Peer Review of sliding fee application and verification of patient income and family
size.
2. Enhance training materials to support Front Desk Staff with assessing sliding fee applications.
3. Quarterly feedback to Front Desk Staff based on sliding fee applications reviewed.
Person Responsible: Kristopher D. Zuniga
Position of Responsible Party: Chief Financial Officer
Completion Date: April 30, 2023