HORIZON HEALTH CARE, INCNon-Profit

2024-001 Noncompliance – Application of SFS Discount Federal Programs – 93.224 & 93.527 Health Center Cluster Criteria – Horizon is required to have a schedule of fees or payments for the provision of their health services consistent with locally prevailing rates or charges and designed to cover the reasonable costs of operation. The corresponding schedule of discounts applied and adjusted should be based on a patient’s ability to pay. The patient’s ability to pay is determined based on the official poverty guidelines, as revised by the U.S. Department of Health and Human services. Condition – During our testing of the Sliding Fee Schedule (SFS), we noted Horizon properly had a SFS schedule whereby the basis of the patient’s ability to pay is based upon the patient’s income, using the federal poverty guidelines as a basis for the percentage of the SFS discount. We tested a total of forty patient visits that received SFS adjustment and noted one of those visits tested was not handled in accordance with Horizon’s SFS policies and procedures. Cause – Horizon did not follow policies and procedures set in place to ensure SFS discount is correctly determined and applied to patient accounts. Context – In one of the forty patient files tested, the sliding fee adjustment was improperly calculated and was not later corrected. Effect or Potential Effect – The SFS discount applied is incorrect. Questioned costs – None noted. Repeat Finding – This is not a repeat finding. Recommendation – Management should review policies and procedures regarding the SFS program with staff that is responsible for determining the SFS discount. View of Responsible Officials – Management recognized the deficiency and plans to implement the auditor’s recommendation.

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