Finding Text
Finding 2024-001 – Special Tests and Provisions: Sliding Fee Determination and Related Patient Billing
U.S. Department of Health and Human Services
Assistance Listing Number 93.224 / 93.527, Health Center Program Cluster
Criteria: Special Tests and Provisions: Sliding Fee Discounts. All section 330-funded health centers must prepare and apply a sliding fee discount schedule (SFDS), which adjust amount owed for health center services by eligible patients based on the patient’s ability to pay. Management is responsible to ensure controls are in place for patients to be charged in accordance with the SFDS and that income verifications are performed at least annually.
Condition: Patients received a sliding fee discount that was inconsistent with the stated sliding fee discount categories under the Organization’s policy.
Context: A sample of 40 patients were tested out of the total population of 999 encounters. The sampling methodology used is not and is not intended to be statistically valid. 19 patients received a sliding fee adjustment that was inconsistent with the approved policy for the proper sliding fee adjustments based on their income documentation and the organization did not have income documentation for 4 patients that received a sliding fee adjustment.
Effect: Sliding fee discounts were given to patients that were inconsistent with the Organization’s sliding fee discount policy.
Cause: The Organization did not comply with their sliding fee policy. Based on audit procedures performed, the income verification process was applied properly or there was lack of documentation to verify it was applied properly and therefore, patients were not charged the correct amount for the services provided.
Questioned costs: None
Repeat Finding: Is not a repeat finding.
Recommendations: We recommend management continue to ensure all personnel understand the sliding fee scale policy and adhere to the requirements and guidelines set forth in the policy. Procedures should be implemented to ensure that eligible patients receive discounts in accordance with the sliding fee scale and the Organization’s Policy Compliance Manual.