Finding 513061 (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. Criteria: Per 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 6 of 40 sliding fee discounts selected for testing did not have a patient sliding fee application on file. Cause: The Organization could not locate the application forms for the 6 patients and could not determine if the forms were not completed or were not properly retained. Effect: There is an increased risk of discounts being provided to patients whom are not eligible to participate in the sliding fee discount program or participants may receive an incorrect discount if the applications are not being obtained and retained by the Organization. Recommendation: Management should review its procedures for documentation of assessment and re-assessments of patients for the sliding fee schedule program and provide additional training, as deemed necessary. We recommend the Organization periodically review a sample of patients receiving discounts under the sliding fee program to ensure applications are being obtained and retained in accordance with the compliance manual. View of Responsible Officials: Management agrees with the finding and has prepared a corrective action plan.