Finding Text
Finding: 2024-003 Sliding Fee Discounts
Federal Programs: Department of Health and Human Services
Health Center Program Cluster
Assistance Listing No. - 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 are required to document sliding fee discounts in accordance with the Organization’s policies. During compliance testing, it was determined that the Organization did not maintain proper documentation of all necessary elements of sliding fee discounts as required by the Organization’s policy. This was a result of sliding fee applications being incomplete, expired, or missing.
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 from the patients, and that the resulting sliding fee discounts were correctly calculated in accordance with the Organization’s sliding fee policy.
Effect: Documentation to substantiate discounts applied to certain patient accounts was not available for certain sliding fee patient visits during the year.
Questioned Costs: None
Context/Sampling: For 18 of 48 patients selected for testing, sliding fee applications were incomplete, missing, or expired. 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: No
Recommendation: It is recommended that employees be trained to maintain the required documentation, including sliding fee applications, for sliding fee discounts provided. It is also recommended that patient records are reviewed by a supervisor on a periodic basis to ensure that the required documentation is properly maintained.
Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above.
Contact Person: Mark Rajkowski, CEO
Anticipated Date of Completion: October 31, 2024