Finding 539418 (2024-002)

Finding 2024-002: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. For thirty-nine sliding fee discount applicants tested the Center could not provide full documentation required for the applications. For another nine sliding fee discount applicants tested the Center improperly applied the program for an immaterial difference. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the sixty patients reviewed that had received sliding fee discounts, thirty-nine did not have the proper documentation maintained and were written off from sliding fee adjustments and another nine had compliance findings for improper application of the Organization’s sliding fee program noted for the year ended June 30, 2024. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount and redesigned the program effective January 1, 2025.