Finding Text
Finding No.: 2021-007
Federal Agency: U.S. Department of Health and Human Services
AL Program: 93.224 Health Center Program
Federal Award No.: 3 H80CS02467-34-02, 6 H80CS02467-34-03, 3 H80CS02467-34-04,
2 H80CS02467-34-00, 1 H8DCS36516-01-00, 1 H8ECS37981-01-00,
6 H80CS02467-35-02, 6 H80CS02467-35-03, 1 H8CCS34824-01-00
1 H8FCS41190-01-00, 6 H80CS02467-36-08, 5 H80CS02467-36-00
Area: Special Tests and Provisions – Sliding Fee Discounts
Questioned Costs: $1,209
Criteria: In accordance with applicable special tests and provisions requirements for sliding fee discounts, 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.
Condition: For 57 (or 95%) of 60 invoices tested, aggregating $1,569 of $973,460 in total billed amount, patients were not properly billed based on the SFDS. Family income and size are not determining factors when patient services are provided. The discounts were applied and determined based on whether the patient is a resident or a nonresident, tourist or non-tourist, with insurance or none, senior citizen, and behavioral health patient.
No. Hospital
No. Invoice
Number Bill Charge Audit Calculation Overbilled / (Underbilled)
1 30639 674345 $18 $5 $13
2 17749 650946 18 5 13
3 51658 679220 9 – 9
4 87762 653008 21 5 16
5 20033 649309 68 15 53
6 100337 634472 44 10 34
7 39547 643820 17 – 17
8 2603 642508 2 – 2
9 25719 650848 19 10 9
10 23159 665988 2 – 2
11 192 645642 5 – 5
12 104165 668724 20 – 20
13 4785 641898 45 56 (11)
14 14760 658001 $42 $5 $37
15 117589 673704 34 – 34
16 11149 662247 23 10 13
17 57317 666221 5 – 5
18 3139 670270 2 – 2
19 102258 648154 49 15 34
20 95374 662894 55 5 50
21 13731 633477 123 6 117
22 68287 678980 31 5 26
23 45549 649513 5 – 5
24 114000 683812 16 5 11
25 68281 686013 128 – 128
26 42808 695258 44 10 34
27 84611 689021 47 6 41
28 3492 641733 6 5 1
29 42764 675271 13 - 13
30 23943 664656 8 5 3
31 31580 692356 44 31 13
32 42028 655072 9 – 9
33 48835 685960 7 5 2
34 4467 685896 49 18 31
35 14833 678083 8 – 8
36 24584 664517 9 – 9
37 119191 630403 31 – 31
38 31215 645644 51 6 45
39 50445 677256 14 5 9
40 100140 632085 67 10 57
41 5571 673304 3 – 3
42 114601 647495 $24 $15 $9
43 24388 660339 10 5 5
44 3561 690511 4 – 4
45 112788 668194 5 – 5
46 91850 690014 58 – 58
47 65395 630750 8 5 3
48 15720 670735 21 – 21
49 10658 694876 22 16 6
50 7384 638162 15 10 5
51 58429 678081 34 12 22
52 83643 666947 20 – 20
53 11259 685649 66 – 66
54 27698 655658 14 – 14
55 11867 675837 11 10 1
56 17370 676270 14 5 9
57 4906 666942 32 24 8
Total: $1,569 $360 $1,209
Cause: Republic of Palau Public Law (RPPL) 7-13 Section 19, which amends RPPL 5-7, requires Palauan citizens and their spouses to be charged hospital fees at a subsidized rate compared to non-Palauans. Accordingly, the Ministry of Health implemented its sliding fee schedule policy in 2006 in accordance with RPPL 7-13.
The community health centers program adopted its fee schedule policy based on income and family size. However, this policy cannot be implemented without the support of the Olbiil era Kelulau (National Congress).
Effect: The Republic is in noncompliance with applicable special tests and provisions requirements for sliding fee discounts. The reportable questioned cost is $1,209.
Identification as a Repeat Finding: Finding 2020-005 issued by the predecessor auditor.
Recommendation: We recommend that the Republic implement policies related to the sliding fee discount based on family income and size, in accordance with the aforementioned criteria.
Views of Responsible Officials: The Republic’s Corrective Action Plan does not indicate disagreement and provides planned corrective action.