Finding Text
2024 – 001 Special Tests: Application of Sliding Fee Discount
Federal Agency: U.S. Department of Health and Human Services
Federal Program: Consolidated Health Centers Grant
AL Number: 93.224 & 93.527
Award Period: 7/1/23 - 6/30/24
Type of Finding: Material Weakness in Internal Control over Compliance and Compliance
Criteria or Specific Requirement
Per Title 42 Chapter 1 Subchapter D Section 51c303(f), “Health centers must have a schedule of fees
or payments for the provision of their health services consistent with locally prevailing rates or charges
designed to cover their reasonable costs of operation. They are also required to have a corresponding
schedule of discounts applied and adjusted on the basis of the patient’s ability to pay.”
Condition and Context
During our testing of forty sliding fee discounts for health center patients qualifying for reduced charge
visits, we identified two visits didn’t have a sliding fee discount application on file to verify the sliding fee
discount amount.
Effect
Potential that a patient would not receive the appropriate sliding fee discount or may receive a discount
when they have not applied for one.
Questioned Costs
None identified.
Cause
Clerical error in which the sliding fee application was not scanned into the patients file due to lack of an
oversight process in place.
Recommendation
We recommend the Organization to review internal controls in regards to the determination, recording,
and monitoring of the sliding fee process to ensure that appropriate sliding fee rates/categories are
utilized for each sliding fee encounter and that all documentation supporting the sliding discount
provided is retained.
Views of Responsible Officials
The Organization corrected the claims on October 17, 2024 to reverse the sliding fee discounts that
were provided without proper sliding fee application support and billing staff will work with the patients
to attempt to collect the balance. The Organization has made changes to its workflow and provided
education to staff instructing them the importance of sliding fee applications and only applying the
correct sliding fee discount amount when proper documentation support exists.