Finding 512438 (2023-003)

Finding 2023-003: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. There were no documents maintained to support the sliding fee discounts applied to twenty-four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients’ poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services not being discounted properly. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the forty patients reviewed that had received sliding fee discounts, twenty-four compliance findings were noted for the year ended June 30, 2023. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount.