Audit 24281

FY End
2022-12-31
Total Expended
$4.59M
Findings
8
Programs
3
Year: 2022 Accepted: 2023-08-06
Auditor: Kcoe Isom LLP

Organization Exclusion Status:

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Findings

ID Ref Severity Repeat Requirement
25953 2022-001 Significant Deficiency - L
25954 2022-002 Significant Deficiency - N
25955 2022-001 Significant Deficiency - L
25956 2022-002 Significant Deficiency - N
602395 2022-001 Significant Deficiency - L
602396 2022-002 Significant Deficiency - N
602397 2022-001 Significant Deficiency - L
602398 2022-002 Significant Deficiency - N

Contacts

Name Title Type
G6YEDLJ2E4G9 Jessica Lance Auditee
5302734984 Megan Connors Auditor
No contacts on file

Notes to SEFA

Accounting Policies: The accompanying Schedule of Expenditure of Federal Awards (the Schedule) includes the federal grant activity of Western Sierra Medical Clinic, Inc. (the Center) and is presented on the accrual basis of accounting for the year ended December 31, 2022. The information in the Schedule is presented in accordance with the requirements of Uniform Guidance. Because the Schedule presents only a selected portion of the operations of the Center, it is not intended to, and does not, present the financial position, changes in net assets, or cash flows for the Center. The accompanying Schedule of Expenditure of Federal Awards is presented using the cost principles from Title 2 U.S. Code of Federal Regulations Part 200, Uniform Guidance Administrative Requirements, Subpart E Cost Principles. De Minimis Rate Used: Y Rate Explanation: The Center has elected to use the 10% de minimis indirect cost rate from Title 2 U.S. Code of Federal Regulations Part 200, Uniform Guidance Administrative Requirements, Subpart E Cost Principles.

Finding Details

#2022-001 Timeliness of Reporting; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we noted that both of the annual Federal Financial Reports (FFR) were submitted late. Criteria: The FFR is required to be submitted within the timeframe specified in the award terms and conditions. Effect: Continued non-compliance could result in a loss of funding. Context: During our testing, we found 2 of the 3 annual reports tested were submitted late. Cause: Inadequate internal controls and lack of proper staff training. Recommendation: We recommend that the Center develop and implement a formal process to ensure that all required reports are submitted timely in accordance with the award terms and conditions, despite turnover in certain positions. Management Response: See Corrective Action Plan.
#2022-002 Sliding Fee Scale; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we found four errors in the application of the sliding fee scale. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in inequitable access to healthcare services for patients and expose the Center to reputational risks. Context: During our testing, we found 4 of the 40 patients tested were not billed for the proper slide category based on the 2022 sliding fee scale provided by the Center. No questioned costs were identified. Cause: Inadequate internal controls, lack of proper staff training, and insufficient oversight in the application of the sliding fee scale. Recommendation: We recommend that the Center strengthen their internal controls by regularly monitoring patient eligibility and reviewing claims without insurance prior to mailing bills to ensure proper application of the sliding fee scale. Management Response: See Corrective Action Plan.
#2022-001 Timeliness of Reporting; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we noted that both of the annual Federal Financial Reports (FFR) were submitted late. Criteria: The FFR is required to be submitted within the timeframe specified in the award terms and conditions. Effect: Continued non-compliance could result in a loss of funding. Context: During our testing, we found 2 of the 3 annual reports tested were submitted late. Cause: Inadequate internal controls and lack of proper staff training. Recommendation: We recommend that the Center develop and implement a formal process to ensure that all required reports are submitted timely in accordance with the award terms and conditions, despite turnover in certain positions. Management Response: See Corrective Action Plan.
#2022-002 Sliding Fee Scale; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we found four errors in the application of the sliding fee scale. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in inequitable access to healthcare services for patients and expose the Center to reputational risks. Context: During our testing, we found 4 of the 40 patients tested were not billed for the proper slide category based on the 2022 sliding fee scale provided by the Center. No questioned costs were identified. Cause: Inadequate internal controls, lack of proper staff training, and insufficient oversight in the application of the sliding fee scale. Recommendation: We recommend that the Center strengthen their internal controls by regularly monitoring patient eligibility and reviewing claims without insurance prior to mailing bills to ensure proper application of the sliding fee scale. Management Response: See Corrective Action Plan.
#2022-001 Timeliness of Reporting; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we noted that both of the annual Federal Financial Reports (FFR) were submitted late. Criteria: The FFR is required to be submitted within the timeframe specified in the award terms and conditions. Effect: Continued non-compliance could result in a loss of funding. Context: During our testing, we found 2 of the 3 annual reports tested were submitted late. Cause: Inadequate internal controls and lack of proper staff training. Recommendation: We recommend that the Center develop and implement a formal process to ensure that all required reports are submitted timely in accordance with the award terms and conditions, despite turnover in certain positions. Management Response: See Corrective Action Plan.
#2022-002 Sliding Fee Scale; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we found four errors in the application of the sliding fee scale. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in inequitable access to healthcare services for patients and expose the Center to reputational risks. Context: During our testing, we found 4 of the 40 patients tested were not billed for the proper slide category based on the 2022 sliding fee scale provided by the Center. No questioned costs were identified. Cause: Inadequate internal controls, lack of proper staff training, and insufficient oversight in the application of the sliding fee scale. Recommendation: We recommend that the Center strengthen their internal controls by regularly monitoring patient eligibility and reviewing claims without insurance prior to mailing bills to ensure proper application of the sliding fee scale. Management Response: See Corrective Action Plan.
#2022-001 Timeliness of Reporting; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we noted that both of the annual Federal Financial Reports (FFR) were submitted late. Criteria: The FFR is required to be submitted within the timeframe specified in the award terms and conditions. Effect: Continued non-compliance could result in a loss of funding. Context: During our testing, we found 2 of the 3 annual reports tested were submitted late. Cause: Inadequate internal controls and lack of proper staff training. Recommendation: We recommend that the Center develop and implement a formal process to ensure that all required reports are submitted timely in accordance with the award terms and conditions, despite turnover in certain positions. Management Response: See Corrective Action Plan.
#2022-002 Sliding Fee Scale; AL#: 93.224 and 93.527; Program: Health Center Cluster Condition: As a result of our audit procedures, we found four errors in the application of the sliding fee scale. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in inequitable access to healthcare services for patients and expose the Center to reputational risks. Context: During our testing, we found 4 of the 40 patients tested were not billed for the proper slide category based on the 2022 sliding fee scale provided by the Center. No questioned costs were identified. Cause: Inadequate internal controls, lack of proper staff training, and insufficient oversight in the application of the sliding fee scale. Recommendation: We recommend that the Center strengthen their internal controls by regularly monitoring patient eligibility and reviewing claims without insurance prior to mailing bills to ensure proper application of the sliding fee scale. Management Response: See Corrective Action Plan.