Finding 3377 (2022-004)

Federal Agency: U.S. Department of Health and Human Services Federal Program Title: Health Center Program Cluster Assistance Listing Number: 93.224 and 93.527 Federal Award Identification Number and Year: H80CS24102-10 Award Period: May 1, 2021 through April 30, 2022 Type of Finding: Significant Deficiency in Internal Control over Compliance and Compliance. Criteria or Specific Requirement: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. (42 USC 254(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)). Condition: The organization had assessed four patients with the incorrect sliding fee discount; three patients were assessed a lower discount and one patient was assessed a higher discount based on their family size and income information that was documented. Questioned Costs: None. Context: For 4 of the 25 sliding fee encounters tested, the sliding fee discount applied to the encounter did not match the sliding fee application provided. Cause: There was no process to review sliding fee discounts applied to patient balances prior to finalizing them. Effect: Applicants assessed are not charged according to the Organization's sliding fee scale and their ability to pay. Repeat Finding: Yes – repeat of 2021-001. Recommendation: Management should consider increasing the frequency of its internal audits over patient encounters or expanding its sample sizes in addition to providing additional training for front desk staff regarding the collection and verification of patient information for each patient. Views of responsible officials: There is no disagreement with the audit findings.