Finding 499821 (2023-003)

Criteria Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must also implement internal controls to ensure that the calculation is determined correctly and is supported. Condition Wipfli reviewed 40 sliding fee charges to test if the amount charged, was calculated properly based on the patients’ income level, family size and in compliance with Outreach Community Health Center's’ sliding fee policy. Wipfli noted that 12 of the charges to sliding fee were produced in Outreach's system due to an improper box being checked which caused the write off of the balance in the system as a sliding fee charge to patients not eligible for sliding fee. Wipfli noted that in 7 of the 40 cases, a sliding fee discount was given to a patient who did not qualify for the a sliding fee discount or support was not maintained for the discount given, and Wipfli noted 1 out of 40 cases where the amount of the sliding fee adjustment applied to the patient's account was incorrectly determined. Cause and Effect Outreach Community Health Centers did not consistently follow the Organization’s policies for approving, documenting and calculating charges for services when using the sliding fee scale and sliding fee discounts were applied in error to certain accounts due to staff incorrectly marking them as sliding fee patients. Auditor’s Recommendation Implement effective internal controls that ensure that all policies and procedures related to the sliding fee are followed and that sliding fee discounts are reviewed to determine that the proper discounts were applied and documentation was retained or documented. Internal controls would include review and approval on all sliding fee determinations and a review of discounts given to sliding fee patients in order to detect sliding fee discounts given in error. View of Responsible Officials Management agrees with the findings and has committed to a corrective action plan.