Finding 584535 (2022-005)

Finding 2022-005: Sliding Fee Assistance listing No. 93.224 Health Center Program Cluster Questioned Costs - N/A Criteria 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. The health center must also implement internal controls to ensure that the calculation is determined correctly and is supported. Condition Wipfli reviewed 40 sliding fee charges to test if the amount charged, was calculated properly based on the patients’ income level and in compliance with Outreach Community Health Center's’ sliding fee policy. Wipfli noted that 7 of the charges were not properly determined based on patients family size and income level, in addition Wipfli noted that 6 files did not contain approval of the sliding fee calculation. Cause and Effect Outreach Community Health Centers did not consistently follow the Organization’s policies for approving, documenting and calculating charges for services when using the sliding fee scale. As a result patients two patients were charged the improper sliding fee amount, one patient was included in the sliding fee program without documentation of family size or income, and the sliding fee discount was applied to four patient balances as Outreach Community Health Centers wrote off the account. Auditor’s Recommendation Implement effective internal controls that ensure that all policies and procedures related to the sliding fee are followed and that sliding fee discounts are reviewed to determine that the proper discounts were applied and documentation was retained or documented. Internal controls would include review and approval on alll slding fee determinations and a review of discounts given to sliding fee patients. View of Responsible Officials Management agrees with the findings and has committed to a corrective action plan.