Finding Text
Significant Deficiency – Sliding Fee Discount Program
Information on Federal Program:
U.S. Department of Health and Human Services – Health Center Program Cluster AL# 93.224
and 93.527
Criteria
Section 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)) requires that health centers provide discounted fees for
individuals and families with incomes above 100% and at or below 200% of the federal poverty
guidelines.
Condition
For the year ended January 31, 2025, we requested the supporting documentation for a sample
of patient visits with discounted fees under the sliding fee program to support that patients were
eligible for the discount and that it was applied in accordance with the Center’s internal policies
and procedures. In a sample of 40 patient visits, we noted one patient visit where discounted
fees were applied incorrectly and one where the SFS audit form was incomplete.
Cause
Internal controls, while designed appropriately, were not implemented consistently to allow for
the detection and correction of these types of errors.
Effect or potential effect
The sliding fee discount program may not be operating in accordance with federal regulations
causing a potential loss of funding.
Questioned costs
None noted.
Context
One patient visit had the sliding fee discount applied to their account at a higher level than what
they qualified for based on their income and family size. One patient’s SFS audit form was
completed incorrectly with the income verification not fully supported based on the
Organization’s policy.
Repeat finding
This is a repeat finding of finding 2024-003 from the prior year.
Recommendation
The entity should revisit their current internal control policies and provide additional training for
staff to ensure compliance with documented controls. Additional research should be done into
the cause of the incorrectly applied sliding fee discounts to determine if this was a system issue
to determine the best course of action. If this is determined to be a manual adjustment done
incorrectly, we recommend additional training be provided to staff as well as additional controls
to review the manually applied discounts for accuracy.