Finding 48581 (2022-001)

2022-001 Sliding Fee Discount Determination ALN: 93.224 Program: Community Health Center Cluster Agency: US Department of Health and Human Services Compliance Requirement: N- Special Tests and Provisions Repeat Finding: No Criteria: Federal grant compliance provisions require that LifeLong correctly identify a patient's ability to pay and that the rates for services be adjusted accordingly based on the sliding fee schedule. LifeLong is required to follow its sliding fee policy when providing discounts to eligible patients. Finding/ Condition: In our sample of 40 tested items, patient information was inadequate to determine the proper sliding fee discount or the patient was given incorrect discounts based on information provided. Questioned Cost: None. Effect: Lack of strict enforcement of the policy of sliding fee eligibility determination and compliance may have resulted in LifeLong providing discounted services greater to or less than the appropriate amounts to beneficiaries. Cause: Inadequate understanding of the sliding fee program requirements and LifeLong policies by employees involved in sliding fee determination. Recommendation: Training should be provided to employees on the sliding fee program requirements. LifeLong should perform regular audits of sliding fee transactions to identify weaknesses in compliance. Views of Responsible Officials and Corrective Action Plan: LifeLong agrees with the finding and will implement additional controls to ensure that this does not recur. Please refer to the corrective action plan on page 58.