Finding 501505 (2023-002)

Finding 2023-002 U.S. Department of Health and Human Services ALN: 93.224/93.527 Health Centers Cluster N – Special Tests and Provisions Condition: The Organization did not properly maintain documentation to support the qualification and sliding fee discount received and did not properly calculate the sliding fee discount in accordance with their policy. This finding is repeated from 2022-003. Criteria: According to the Health Center Program Compliance Manual Chapter 9: Sliding Fee Discount Program, a health center is required to have operating procedures for assessing/re-assessing all patients for income and family size consistent with Board-approved sliding fee discount program policies. Context: In our testing of patients receiving discounts under the Organization’s sliding fee schedule, we observed that 2 of 40 sliding fee discounts had an incorrect discount applied to the patient. In addition, 8 of 40 sliding fee discounts selected for testing did not have a patient sliding fee application on file. Cause: Due to staffing constraints in the Organization, there was a lack of formal review and approval procedures for patients applying for the sliding fee discount program, and some documentation was not filed properly. Effect: Discounts may be given to patients not eligible to receive a discount, or incorrect discounts may be provided for patients eligible to receive a discount if the applications are not being properly obtained and reviewed and approved by the Organization. Recommendation: We recommend the Organization review its processes and procedures for completing the review and approval process for patient applying for the sliding fee discount program and provide additional training to all employees involved in the process. In addition, we recommend the Organization periodically review patients receiving discounts under the sliding fee discount program to help ensure applications and income support have been obtained in accordance with the Organization’s policies. View of Responsible Officials: Management agrees with the finding and has prepared a corrective action plan.