Finding Text
2023-003, 2022-003 – Material Weakness and Material Noncompliance – Special Tests
Federal Program: Assistance Listing #93.224 and 93.527, Health Center Program Cluster, Department of Health and Human Services
Criteria: Health Centers must prepare and apply a sliding fee discount schedule so that amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay.
Condition: During our testing of sliding fee encounters we noted 15 instances out of 60 where the patient was not slid the proper amount based on their level of income. Additionally, out of the 60 sliding fee adjustments tested, we noted 5 instances where the center was not able to locate the sliding fee application for the applicable patient, however a sliding fee adjustment was still applied. Also, there were 3 instances where the sliding fee application that was on file for the patient tested was 2 years old and has not been updated.
Questioned Costs: N/A
Cause and Effect: There has been significant turnover in the billing department over the past 3 years, as well as implementation of new billing software. Many instances are due to improper documentation or manual error in inputting the patients’ slide scale.
Recommendation: We recommend that management reviews all current sliding fee patients and ensure that the center has an up to date sliding fee application for each. If the center is not able to locate the sliding fee application, then we recommend that the center obtains the proper application. Additionally, we recommend that the center reviews current applications to ensure that patients are being charged the proper sliding fee scale.
Views of Responsible Officials: Management agrees with the finding.
Corrective Action Plan: See attached corrective action plan.