Finding Text
Finding Number: 2023-001
Finding Type: Compliance - Special Tests and Provisions
Information on the Federal Program: Program Name: Health Center Program Cluster (AL numbers 93.224 and 93.527)
Grant Award: 6 H80CS00797-21-01 from January 1, 2023 through December 31, 2023
Agency: U.S. Department of Health and Human Services, HRSA
Pass-Through Entity: N/A
Criteria: In accordance with Section 330(k)(3)(G) of the Public Health Services Act (42 U.S. Code § 254b), as an FQHC, the Organization must have a sliding fee discount program in which the Organization’s fee schedule is discounted based on a patient’s ability to pay.
Condition: The Organization has not applied sliding fee discounts to patient charges consistent with its sliding fee discount program. Through testing a statistically valid sample of transactions for the appropriate application of the Organization's sliding fee discount program to 25 individual patient balances, we noted the sliding fee discount applied was not consistent with the Organization's sliding fee discount policy for one patient. Based on income and family size, the patient qualified for a patient responsibility of $90 but received a patient responsibility of $72.
Cause: Approval of the sliding fee discount applications involves manual processes and errors can occur. To help mitigate errors, the Organization has implemented semi-annual monitoring procedures which include the sampling of discounts provided to ensure the discounts were applied to patient accounts appropriately. The volume of discounts provided to patients annually does not allow for 100% review of all patient discounts. Due to the inherent nature of sampling, all errors may not be identified and corrected.
Effect: It is possible the Organization may not apply sliding fee discounts to patient charges consistent with its sliding fee discount program.
Questioned Costs: None
Repeat Finding: No
Recommendation: We recommend management consider increasing the number of transactions reviewed as part of the Organization's internal monitoring procedures and the frequency of monitoring procedures.
Views of a Responsible Official and Corrective Action Plan: Management agrees with the finding and will review internal monitoring procedures for opportunities for improvement to increase compliance with the program requirements.