Finding 518 (2023-001)

Criteria: The Health Center Cluster requires the Organization to perform a financial assessment on consumers in order to place them on a sliding fee scale. The sliding fee scale must be based on the current Federal Poverty Guidelines at the time of assessment. Condition: Consumers are not always placed correctly on the sliding fee scale based on their household size and income level. Questioned Costs: None Context: We tested 25 consumer files for proper placement on the sliding fee scale. During this test we found 1 consumer file where the consumer was incorrectly placed on sliding fee scale D. The consumer should have been placed on sliding fee scale E (100% self-pay). Effect: Consumers may not be appropriately placed on the sliding fee scale. Cause: The Organization's controls over placement of consumers on the sliding fee scale necessary for financial assessment of consumers are not operating effectively. Recommendation: The Organization should review procedures and training regarding the sliding fee scale calculation and placement.