Finding Text
Finding: 2023-001 Sliding Fee Discounts
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
CFDA 93.224 and 93.527
Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303
Condition: Health centers that receive funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by eligible patients are discounted based on the patient’s ability to pay. During compliance testing, it was determined that the Organization did not obtain and properly document all necessary elements required by the Organization’s policy.
Cause: There were deficiencies in internal controls over the Organization’s sliding fee program. For certain patient accounts that were tested as part of the audit, the Organization was unable to substantiate that proper documentation was obtained and that proper sliding fee discounts were applied to patient accounts in accordance with the Organization’s sliding fee scale.
Effect: Proper documentation was unavailable to substantiate that discounts were properly applied to patient accounts.
Questioned Costs: None
Context/Sampling: For 4 of 48 patients selected for testing, incorrect discounts were provided. Two patients received an incorrect discount; one patient received a discount who did not qualify for a discount; and one patient who qualified for a discount was not provided a discount. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue.
Repeat Finding from Prior Year: Yes
Recommendation: It is recommended that employees are properly trained to document and apply the sliding fee discounts in accordance with the Organization’s sliding fee policy. It is also recommended that sliding fee discounts are reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale.
Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above.
Contact Person: Jennifer Dittes, CEO
Anticipated Date of Completion: May 31, 2024