Open Door Family Medical Center, Inc.

Finding 2023-001 - Special Tests and Provisions: Sliding Fee Discounts 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), COVID-19 - 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), Grants for New and Expanded Services Under the Health Center Program and COVID-19 - Grants for New and Expanded Services Under the Health Center Program (Assistance Listing Number 93.527). 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. Cause The patient services representative made an error in applying the correct sliding fee discount based on the patient's household income and number of dependents. Effect The amount owed for the services provided was not based on the Center's SFDS. Questioned Costs None Context One exception from a statistically valid sample of 40. Identification of Repeat Finding No Recommendation We recommend that the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance. Corrective Action: All supervisors conducted training sessions for all staff members involved in patient registration and billing processes to reinforce proper documentation and application of the sliding fee discount schedule. Further, the Center has implemented an internal audit/review system to ensure that the sliding fee discount schedule is properly applied based on patient information.