Finding Text
Special Tests and Provisions
Federal agency: U.S. Department of Health and Human Services
Federal program title: Health Center Program Cluster (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care)
Assistance Listing Number: 93.224/93.527
Federal Award Identification Number: H8026575-2023, H8026575-2024, H8G48725-2022
Award Period: December 2022 through February 2025
Type of Finding: Significant Deficiency in Internal Control over Compliance
Criteria or specific requirement: Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay per the grant requirements.
Condition: During our testing, we noted a breakdown in internal controls over determining patient eligibility for the sliding fee discount.
Questioned costs: None
Context: In a sample of 25 patients, 1 patient was noted as eligible per the updated Federal Poverty Guidelines (FPG) and SFDS effective March 2024. This patient did not qualify for a sliding fee discount under the previous SFDS. The slide did not calculate properly resulting in the patient paying more than what they would have had they been assessed the correct sliding fee.
Cause: The SFDS updated in March 2024 for annual FPG adjustments was not entered into the client’s billing software; therefore, the slide calculated by the billing software for this patient was based on the previous FPG instead of the updated FPG. The slide determination for this patient would have changed with the new income thresholds per the updated SFDS.
Effect: A patient who is eligible for a sliding fee discount under updated FPG did not receive the appropriate discount.
Repeat Finding: No
Recommendation: We recommend that a test is performed in the billing software annually when the updated SFDS is put into place to ensure that slides are being calculated appropriately at the effective date of the new schedule.
Views of responsible officials: There is no disagreement with the audit finding.