Audit 320377

FY End
2023-12-31
Total Expended
$20.41M
Findings
14
Programs
11
Year: 2023 Accepted: 2024-09-23
Auditor: Bonadio & CO LLP

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
497598 2023-003 Significant Deficiency - N
497599 2023-003 Significant Deficiency - N
497600 2023-003 Significant Deficiency - N
497601 2023-003 Significant Deficiency - N
497602 2023-003 Significant Deficiency - N
497603 2023-003 Significant Deficiency - N
497604 2023-003 Significant Deficiency - N
1074040 2023-003 Significant Deficiency - N
1074041 2023-003 Significant Deficiency - N
1074042 2023-003 Significant Deficiency - N
1074043 2023-003 Significant Deficiency - N
1074044 2023-003 Significant Deficiency - N
1074045 2023-003 Significant Deficiency - N
1074046 2023-003 Significant Deficiency - N

Contacts

Name Title Type
E9LST6Z4HMK6 Jose Virella Auditee
2127697245 Karen Lynch Auditor
No contacts on file

Notes to SEFA

Title: Non-Cash Awards Accounting Policies: 1.BASIS OF PRESENTATION: The accompanying schedule of expenditures of federal awards (the Schedule) summarizes the expenditures of William F. Ryan Community Health Center, Inc. (Ryan Health) under programs of the federal government for the year ended December 31, 2023, and has been prepared in conformity with accounting principles generally accepted in the United States. The information in this schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the schedule presents only a selected portion of the operations of Ryan Health, it is not intended to and does not present the financial position, changes in net assets, or cash flows of Ryan Health. For the purposes of the schedule, federal awards include all grants, contracts, and similar agreements entered into directly between Ryan Health and agencies and departments of the federal government as well as federal awards passed through other agencies. 2.BASIS OF ACCOUNTING: Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. Ryan Health received noncash assistance of $1,676,405 in the form of immunization vaccines for Federal Assistance Listing number 93.268 during the year ended December 31, 2023, which were passed through the City of New York Department of Health and Mental Hygiene. Distribution of the immunizations is reflected in the Schedule. Nonmonetary assistance is reported in the Schedule at the fair value of the WIC checks received. The total federal share of food instruments distributed by Ryan Health amounted to $2,771,239.

Finding Details

Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.
Criteria - Health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The health center must demonstrate adjustments to charges are consistent with the health center’s SFDS. Condition - We attempted to recalculate the applied discount using Ryan Health’s policy and the patient documentation provided, noting instances where the adjustments to charges were inconsistent with Ryan Health’s SFDS. Cause - Lack of controls to ensure that staff are obtaining required documentation and entering the information correctly. Effect - Out of our sample of 20 selections, we identified eleven exceptions based on the SFDS. Seven of the discounts entered lacked the required slide documentation, the slide form had expired and was not updated, or the document was updated, but the data in the system was not resulting in the slide that was provided not being supported or applied incorrectly. Four of the discounts were improperly adjusted during the billing or review process based on insurance or payments received, or incorrect charges being calculated and applied to the total slide for the remaining patient balance. Recommendation - Providing the sliding fee to patients is a requirement of specific grant funds received. As such, we recommend Ryan Health review the current procedures in place and consider additional and more frequent training for all employees involved in the process. We encourage management to consider appointing an individual at the various locations to assist the front desk staff with the sliding fee process to ensure required documentation is captured and recorded accurately in the billing system. We also encourage Ryan Health to consider assigning a dedicated individual to regularly review the sliding fee visits to ensure compliance. This should be someone who is knowledgeable of the sliding fee requirements and Ryan Health’s billing processes and procedures.