Finding Text
#2022-002 Sliding Fee Scale; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we found four errors in the application of the sliding fee scale. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in inequitable access to healthcare services for patients and expose the Center to reputational risks. Context: During our testing, we found 4 of the 40 patients tested were not billed for the proper slide category based on the 2022 sliding fee scale provided by the Center. No questioned costs were identified. Cause: Inadequate internal controls, lack of proper staff training, and insufficient oversight in the application of the sliding fee scale. Recommendation: We recommend that the Center strengthen their internal controls by regularly monitoring patient eligibility and reviewing claims without insurance prior to mailing bills to ensure proper application of the sliding fee scale. Management Response: See Corrective Action Plan.