Finding Text
2023-002 Application of Sliding Fee Discount
Program Information
Federal Organization U.S Department of Health and Human Services
Assistance Listing
Numbers
93.224 & 93.527 Health Center Program Cluster
Award Numbers H80CS00540-21, H8FCS41201, H8GCS48292
Criteria [X] Compliance Finding [ ] Significant Deficiency [ ] Material Weakness
Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform
Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards, Subpart F, Compliance Supplement, Part 4, Compliance
Requirement N, Special Tests and Provisions states, “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 patients ability to pay.”
Condition During our testing of sliding fee discounts for health center patients qualifying
for reduced-charge visits, we identified two incidents where the slide fee was
applied to a patient’s account without a completed application on file.
Context This finding appears to be an isolated incident. A sample size of 25 patients
included two who did not have an application on file.
Cause The Organization did not follow its policies and procedures set in place to
ensure the sliding fee schedule discount is correctly determined and applied to
patient accounts.
Effect Patients may have been granted the incorrect sliding fee discount.
Questioned Costs None identified
Recommendation We recommend continued effort in training personnel to be properly trained
on applying appropriate sliding fee discounts based on the Organization’s
approved policy and in compliance with the OMB Compliance Supplement
requirements. An appropriate level of review should be conducted on patient
accounts to ensure proper document retention, application of sliding fee
discounts, and third-party insurance billing.
Views of responsible
officials and planned
corrective action
Management is in agreement with the audit finding.