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Section III - Federal Award Findings and Questioned Costs U.S. Department of Health and Human Services: Health Centers Program Cluster (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) (Assistance Listing Number 93.224) and Grants for New and Expanded Services Under the Health Center Program (Assistance Listing Number 93.527). Finding 2022-001 - Special Tests and Provisions: Sliding Fee Discounts Criteria In accordance with 42 CFR sections 51c.303(f) and (g), health centers must prepare and apply a sliding fee discount schedule ("SFDS") so that the amounts paid for health center services by eligible patients are adjusted (discounted) based on the patient's ability to pay. Statement of Condition During our audit, we noted that the SFDS was not properly applied to a patient due to an error made by the patient services representative. Questioned costs None Cause The patient services representative did not record within the billing system, the patient's household income and number of dependents. Effect The amounts owed for the services provided were not based on the Center's SFDS. Context One exception from a statistically valid sample of 25. Identification of Repeat Finding No Recommendation We recommend that proper training be given to the patient services representatives, and the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance. Management Response All supervisors were mandated to conduct training sessions for all staff members involved in patient registration and billing processes. The Center has improved communication between the registration and billing personnel, to ensure that patient information and financial details are accurately shared to minimize the risk of errors. The Center is in the process of updating its documentation processes to include clear guidelines on handling sliding fee scale patients, along with mandatory checklists to ensure all steps are followed correctly.