Finding Text
FINDING 2024-004
Special Tests and Provisions – Application of Sliding Fees
FINDING TYPE
Significant Deficiency in Internal Control over Compliance
AGENCY
U.S. Department of Health and Human Services
ALN
93.224 / 93.527 Health Center Cluster
CRITERIA
In accordance with 42 USC 254b(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and
(g); and 42 CFR sections 56.303(e), (f), and (g) 2 CFR 200.302 (b)(3), health centers must
prepare and apply a sliding fee discount schedule (SFDS) so that amounts owed for health
center services by eligible patients are adjusted (discounted) based on the patient’s ability to
pay.
CONDITION AND CONTEXT
During the year ended June 30, 2024, out of a sample of 40 transactions, we noted 12
instances where the sliding fee discount was either incorrectly calculated or not applied. In
addition, we noted 4 items for which documentation supporting the fee was not available.
The known error in the sample was $725 and the projected total error was $4,169.
CAUSE
Given the volume of patients served by the health center program, there were instances where
the staff made errors in the application of the SFDS.
EFFECT OR POTENTIAL EFFECT
The organization was not consistently in compliance with the SFDS requirements of the
health center program.
REPEAT FINDING
No.
RECOMMENDATION
We recommend that the organization implement a review of its SFDS protocols and adjust
processes and retrain staff to ensure consistent application of the SFDS.
VIEWS OF RESPONSIBLE OFFICIALS AND PLANNED CORRECTIVE ACTION
See attached corrective action plan.
Questioned Costs
None.