Finding 579629 (2023-001)

Finding: 2023-001 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health centers that receive funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by eligible patients are discounted based on the patient’s ability to pay. During compliance testing, the following errors were noted: • A patient, whose visit was tested as part of the audit, received a discount for which the self-declaration for income had expired. • A patient, whose visit was tested as part of the audit, received a discount when the Organization didn't have a sliding fee application on file to document family size and income. • A patient, whose visit was tested as part of the audit, received a discount when the patient's income exceeded 200% of federal poverty guidelines. Cause: There were deficiencies in internal controls over the Organization’s sliding fee program. For certain patient accounts that were tested as part of the audit, the Organization was unable to substantiate that proper documentation was obtained and that proper sliding fee discounts were applied to patient accounts in accordance with the Organization’s sliding fee scale. Effect: Discounts were not properly applied to patient accounts. Questioned Costs: None reported Context/Sampling: For 3 of 20 patients selected for testing, the account had an incorrect discount applied. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that employees are properly trained to document and apply the sliding fee discounts in accordance with the Organization’s sliding fee policy. It is also recommended that sliding fee discounts are reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Marlita White, CEO Anticipated Date of Completion: December 31, 2023