Finding 4328 (2023-002)

inding 2023-002 Program Name/AL Title: Health Center Program Cluster Federal Assistance Listing Number: 93.224 and 93.527 Federal Agency: U.S. Department of Health and Human Services Type of Finding: Significant Deficiecy/Noncompliance Compliance Requirement: Special Tests and Provisions Condition: The Organization lacked adequate controls over its sliding fee discount program to ensure that patients received the correct discount. Criteria: Health Centers must maintain a sliding fee discount policy and apply a sliding fee discount based on patient's ability to pay (42 USC 254(k((3)(E), (F), (G); 42 CFR sections 53c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)). Context: In testing patients receiving discounts under the Organization's sliding fee schedule, we noted that for 4 of 42 patients selected for testing the Organization incorrectly applied the discount or were put in the incorrect category based on income and family size. Cause: The Organization's review process was not effective in verifying the sliding fee discount was correctly calculated and applied in accordance with the Organization's policy. Effect: There is an increased risk that discounts may be given to patients not eligible to receive a discount, or incorrect discounts may be provided for patient eligible to receive a discount. Recommendation: We recommend the Organization periodically review patients receiving discounts under the sliding fee schedule program to ensure that the correct discounts are being applied based on the current sliding fee schedule. View of Responsible Officials: The Organization will implement procedures for reviewing sliding fee discounts and provide additional training to staff for calculating those discounts.