Finding Text
2024-001 Noncompliance – Application of SFS Discount
Federal Programs – 93.224 & 93.527 Health Center Cluster
Criteria – Horizon is required to have a schedule of fees or payments for the provision of their
health services consistent with locally prevailing rates or charges and designed to cover the
reasonable costs of operation. The corresponding schedule of discounts applied and adjusted
should be based on a patient’s ability to pay. The patient’s ability to pay is determined based on
the official poverty guidelines, as revised by the U.S. Department of Health and Human
services.
Condition – During our testing of the Sliding Fee Schedule (SFS), we noted Horizon properly
had a SFS schedule whereby the basis of the patient’s ability to pay is based upon the patient’s
income, using the federal poverty guidelines as a basis for the percentage of the SFS discount.
We tested a total of forty patient visits that received SFS adjustment and noted one of those
visits tested was not handled in accordance with Horizon’s SFS policies and procedures.
Cause – Horizon did not follow policies and procedures set in place to ensure SFS discount is
correctly determined and applied to patient accounts.
Context – In one of the forty patient files tested, the sliding fee adjustment was improperly
calculated and was not later corrected.
Effect or Potential Effect – The SFS discount applied is incorrect.
Questioned costs – None noted.
Repeat Finding – This is not a repeat finding.
Recommendation – Management should review policies and procedures regarding the SFS
program with staff that is responsible for determining the SFS discount.
View of Responsible Officials – Management recognized the deficiency and plans to implement
the auditor’s recommendation.