Finding Text
Finding 2023.001: Special Tests and Provisions
Grantor: U.S. Department of Health and Human Services
Federal Program Names: Health Center Program Cluster, Health Center Program
(Community Health Centers, Migrant Health Centers,
Health Care for the Homeless, and Public Housing Primary
Care), COVID-19 Health Center Program (Community
Health Centers, Migrant Health Centers, Health Care for
the Homeless, and Public Housing Primary Care), Grants
for New and Expanded Services under the Health Center
Program, COVID-19 Grants for New and Expanded
Services under the Health Center Program.
Federal Assistance Listing Numbers: 93.224 and 93.527
Criteria
Health centers are required to have a corresponding schedule of discounts applied and adjusted on
the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on
the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5),
56.108(b)(5) and 56.303(f)). The Organization should be implementing and monitoring procedures
to properly determine, calculate and review sliding fee discounts issued to patients in accordance
with the Organization's sliding fee scale.
Condition
The Organization did not always appropriately apply the sliding fee discount based on income
levels.
Cause
The Organization did not have adequate internal controls in place to effectively ensure that patients
receive the correct sliding fee discount.
Effect
The Organization did not comply with the appropriate rules and regulations as per the Uniform
Guidance.
Questioned Costs
None.
Context
A test of 40 slide fee discount transactions was performed and resulted in six instances of sliding
fee discounts not being properly calculated based on the respective patient family size and income
or was not in agreement with the supporting documentation. Our sample was a statistically valid
sample.
Identification as Repeat Finding
Yes - Finding 2022.001.
Recommendation
The Organization should strengthen internal controls in place to effectively ensure that patients
receive the correct sliding fee discount.
Views of Responsible Officials and Planned Corrective Actions
Management agrees with the audit finding and will strengthen internal controls and accountability to
correct the deficiency.