Finding Text
2023-001, 2022-001, 2021-001 – Material Weakness and Material Noncompliance – Special Tests – Sliding Fee
Program information: AL # 93.224 and 93.527, Health Center Program Cluster, Department of Health and Human Services.
Criteria: Health centers must obtain sliding fee applications so that amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay.
Condition: We tested 60 sliding fee encounters and noted that 10 out of 60 patients were discounted, charged or adjusted the wrong amount and 4 out of 60 patients sliding fee applications had documentation issues.
Questioned Costs: None.
Cause and Effect: The Organization failed to verify sliding fee applications were obtained for all patients receiving discounts and incorrectly applied sliding fee discounts, charges or adjustments to encounters.
Recommendation: We recommend the Organization continue with the corrective action plan implemented in the prior year in response to audit findings 2022-001 and 2021-001 to ensure sliding fee applications are completed before encounters are billed. We recommend that management continue to review and monitor the internal sliding fee application auditing process for further improvements and consider increasing sample sizes.
Views of Responsible Officials: Management agrees with the finding.
Corrective Action Plan: See attached corrective action plan.