Audit 303514

Condition: The Organization did not properly maintain documentation to support the qualification and sliding fee discount received and did not properly calculate the sliding fee discount in accordance with their policy. This finding is repeated from 2021-003. Criteria: According to the Health Center Program Compliance Manual Chapter 9: Sliding Fee Discount Program, a health center is required to have operating procedures for assessing/re-assessing all patients for income and family size consistent with Board-approved sliding fee discount program policies. Context: In our testing of patients receiving discounts under the Organization’s sliding fee schedule, we observed that 2 of 40 sliding fee discounts had an incorrect discount applied to the patient. In addition, 7 of 40 sliding fee discounts selected for testing did not have a patient sliding fee application or required income verification on file. Additionally, it was observed that the Organization did not update its sliding fee discount scale for the year ended June 30, 2022. Cause: Due to staffing constraints in the Organization, there was a lack of formal review and approval procedures for patients applying for the sliding fee discount program, and some documentation was not filed properly. Effect: Discounts may be given to patients not eligible to receive a discount, or incorrect discounts may be provided for patients eligible to receive a discount if the applications are not being properly obtained and reviewed and approved by the Organization. Recommendation: We recommend the Organization review its processes and procedures for completing the review and approval process for patient applying for the sliding fee discount program and provide additional training to all employees involved in the process. In addition, we recommend the Organization periodically review patients receiving discounts under the sliding fee discount program to help ensure applications and income support have been obtained in accordance with the Organization’s policies.

Condition: The Organization did not complete the audit required under Uniform Guidance for the year ended June 30, 2022, by the federal due date. In addition, the Organization did not submit the annual Federal Financial Report by the required deadline. Criteria: Uniform Guidance requires audits to be submitted the earlier of 30 days after audit issuance or 9 months after year end. Uniform Guidance requires Federal Financial Reports within 90 days after the reporting period. Cause: Turnover in the chief financial officer position and staffing constraints at the Organization limited the Organization’s ability to be ready for the audit and meet reporting requirements. Effect: The audit was not completed prior to the federal due date. Recommendation: The Organization should plan to have its audit completed prior to the federal due date and establish procedures to assure other reporting requirements required for grant reporting are completed within the required deadlines. View of Responsible Officials: The Organization agrees with the finding and has prepared a corrective action plan to have future audits and reporting requirements completed by the due dates.

Condition: The Organization did not properly maintain documentation to support the qualification and sliding fee discount received and did not properly calculate the sliding fee discount in accordance with their policy. This finding is repeated from 2021-003. Criteria: According to the Health Center Program Compliance Manual Chapter 9: Sliding Fee Discount Program, a health center is required to have operating procedures for assessing/re-assessing all patients for income and family size consistent with Board-approved sliding fee discount program policies. Context: In our testing of patients receiving discounts under the Organization’s sliding fee schedule, we observed that 2 of 40 sliding fee discounts had an incorrect discount applied to the patient. In addition, 7 of 40 sliding fee discounts selected for testing did not have a patient sliding fee application or required income verification on file. Additionally, it was observed that the Organization did not update its sliding fee discount scale for the year ended June 30, 2022. Cause: Due to staffing constraints in the Organization, there was a lack of formal review and approval procedures for patients applying for the sliding fee discount program, and some documentation was not filed properly. Effect: Discounts may be given to patients not eligible to receive a discount, or incorrect discounts may be provided for patients eligible to receive a discount if the applications are not being properly obtained and reviewed and approved by the Organization. Recommendation: We recommend the Organization review its processes and procedures for completing the review and approval process for patient applying for the sliding fee discount program and provide additional training to all employees involved in the process. In addition, we recommend the Organization periodically review patients receiving discounts under the sliding fee discount program to help ensure applications and income support have been obtained in accordance with the Organization’s policies.

Condition: The Organization did not complete the audit required under Uniform Guidance for the year ended June 30, 2022, by the federal due date. In addition, the Organization did not submit the annual Federal Financial Report by the required deadline. Criteria: Uniform Guidance requires audits to be submitted the earlier of 30 days after audit issuance or 9 months after year end. Uniform Guidance requires Federal Financial Reports within 90 days after the reporting period. Cause: Turnover in the chief financial officer position and staffing constraints at the Organization limited the Organization’s ability to be ready for the audit and meet reporting requirements. Effect: The audit was not completed prior to the federal due date. Recommendation: The Organization should plan to have its audit completed prior to the federal due date and establish procedures to assure other reporting requirements required for grant reporting are completed within the required deadlines. View of Responsible Officials: The Organization agrees with the finding and has prepared a corrective action plan to have future audits and reporting requirements completed by the due dates.