Audit 331131

FY End
2024-04-30
Total Expended
$3.27M
Findings
12
Programs
7
Organization: Community Health Partners, Inc. (MT)
Year: 2024 Accepted: 2024-12-05
Auditor: Kcoe Isom LLP

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
513142 2024-001 Significant Deficiency - N
513143 2024-002 Significant Deficiency - L
513144 2024-003 Significant Deficiency - AB
513145 2024-001 Significant Deficiency - N
513146 2024-002 Significant Deficiency - L
513147 2024-003 Significant Deficiency - AB
1089584 2024-001 Significant Deficiency - N
1089585 2024-002 Significant Deficiency - L
1089586 2024-003 Significant Deficiency - AB
1089587 2024-001 Significant Deficiency - N
1089588 2024-002 Significant Deficiency - L
1089589 2024-003 Significant Deficiency - AB

Contacts

Name Title Type
JJEDKELTZA96 Lander Cooney Auditee
4062221111 Megan Connors Auditor
No contacts on file

Notes to SEFA

Title: 4. LOANS OUTSTANDING Accounting Policies: BASIS OF ACCOUNTING The accompanying schedule of expenditures of federal awards includes the federal grant activity of the Community Health Partners, Inc. (the Clinic) and is presented on the accrual basis of accounting for the period July 1, 2023, through April 30, 2024. 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. Therefore, some amounts presented in this schedule may differ from amounts presented in or used in the preparation of the general purpose financial statements. The accompanying schedule of expenditures of federal awards is presented using the cost principles from Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Subpart E Cost Principles. De Minimis Rate Used: Y Rate Explanation: For the U.S. Department of Health and Human Services grants passed through the state of Montana, the Clinic has elected to use the 10% de minimus indirect cost rate from Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Subpart E Cost Principles. The Clinic received a direct loan from the United States Department of Agriculture under Assistance Listing Number 10.766, Community Facilities Loans and Grants. The ending balance of the loan outstanding at April 30, 2024, with continuing compliance requirements was $573,999.
Title: 5. SUBSEQUENT EVENTS Accounting Policies: BASIS OF ACCOUNTING The accompanying schedule of expenditures of federal awards includes the federal grant activity of the Community Health Partners, Inc. (the Clinic) and is presented on the accrual basis of accounting for the period July 1, 2023, through April 30, 2024. 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. Therefore, some amounts presented in this schedule may differ from amounts presented in or used in the preparation of the general purpose financial statements. The accompanying schedule of expenditures of federal awards is presented using the cost principles from Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Subpart E Cost Principles. De Minimis Rate Used: Y Rate Explanation: For the U.S. Department of Health and Human Services grants passed through the state of Montana, the Clinic has elected to use the 10% de minimus indirect cost rate from Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Subpart E Cost Principles. On May 1, 2024, the Clinic successfully completed its merger with Bighorn Valley Health Center, Inc., doing business as One Health, a nonprofit community health center. The merger was executed as planned and previously disclosed in the letter of intent dated November 2023. The combined entity has begun operating under the name, One Health.

Finding Details

Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we noted instances where no supporting eligibility application and income verification were maintained by Community Health Partners, Inc. (the Clinic) to support the sliding fee scale discount adjustment that the patient received. Criteria: The sliding fee scale discount is based on patient income and demographic information. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in improper client billing and loss of revenue. Context: The Clinic did not maintain an eligibility application and income verification for 3 out of 40 patients tested. Cause: The Clinic had no form of secondary review in place, resulting in the errors in improper documentation not being detected and corrected in a timely manner. Recommendation: We recommend a secondary review of the applications and system input to ensure the proper documentation is verified in the electronic health records to support the slide eligibility. Management response: See Corrective Action Plan.
Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures over the UDS report, it was identified that the number of visits reported for physicians was overstated, while those for Nurse Practitioners (NPs) were understated. This discrepancy was due to a system error that incorrectly classified NPs as physicians. Criteria: Accurate reporting of service utilization by specific provider types is crucial for compliance with Department of Health and Human Services guidelines. Effect: Misclassification could lead to non-compliance with grant reporting requirements, potentially affecting the Clinic’s funding and accuracy of statistical data used for healthcare planning and resource allocation. Context: An analysis of visit data revealed that a system coding error led to incorrect provider type attribution where several NPs were recorded as physicians. Cause: Review of the report detected the error but it was not corrected in the final submission. Recommendation: We recommend an immediate review and correction of the errors noted in the accuracy report be completed prior to submission. Management Response: See Corrective Action Plan.
Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we noted an instance that payroll was processed without prior approval from the Chief Executive Officer (CEO) or Chief financial Officer (CFO), which is a violation of the Clinic's internal control policies. Criteria: The Clinic's internal control policies require that all payroll transactions be approved by either the CEO or the CFO before processing to ensure accuracy and compliance with budgetary allocations. Effect: The absence of proper approval could lead to unauthorized or erroneous payroll transactions, potentially resulting in financial misstatements and non-compliance with internal control requirements. This could also affect the Clinic’s financial integrity and accountability. Context: The approval for payroll processing was missing for one out of five payroll periods tested. Cause: The established pre-approval process was inadvertently bypassed by the payroll department staff. Recommendation: We recommend the implementation of a mandatory approval feature within the payroll system that requires sign-off by the CEO or CFO before payroll can be processed. Additionally, training should be provided to all payroll staff on the importance of adhering to internal control policies. Regular audits of payroll approvals should also be instituted to ensure compliance with the policy. Management Response: See Corrective Action Plan.
Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we noted instances where no supporting eligibility application and income verification were maintained by Community Health Partners, Inc. (the Clinic) to support the sliding fee scale discount adjustment that the patient received. Criteria: The sliding fee scale discount is based on patient income and demographic information. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in improper client billing and loss of revenue. Context: The Clinic did not maintain an eligibility application and income verification for 3 out of 40 patients tested. Cause: The Clinic had no form of secondary review in place, resulting in the errors in improper documentation not being detected and corrected in a timely manner. Recommendation: We recommend a secondary review of the applications and system input to ensure the proper documentation is verified in the electronic health records to support the slide eligibility. Management response: See Corrective Action Plan.
Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures over the UDS report, it was identified that the number of visits reported for physicians was overstated, while those for Nurse Practitioners (NPs) were understated. This discrepancy was due to a system error that incorrectly classified NPs as physicians. Criteria: Accurate reporting of service utilization by specific provider types is crucial for compliance with Department of Health and Human Services guidelines. Effect: Misclassification could lead to non-compliance with grant reporting requirements, potentially affecting the Clinic’s funding and accuracy of statistical data used for healthcare planning and resource allocation. Context: An analysis of visit data revealed that a system coding error led to incorrect provider type attribution where several NPs were recorded as physicians. Cause: Review of the report detected the error but it was not corrected in the final submission. Recommendation: We recommend an immediate review and correction of the errors noted in the accuracy report be completed prior to submission. Management Response: See Corrective Action Plan.
Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we noted an instance that payroll was processed without prior approval from the Chief Executive Officer (CEO) or Chief financial Officer (CFO), which is a violation of the Clinic's internal control policies. Criteria: The Clinic's internal control policies require that all payroll transactions be approved by either the CEO or the CFO before processing to ensure accuracy and compliance with budgetary allocations. Effect: The absence of proper approval could lead to unauthorized or erroneous payroll transactions, potentially resulting in financial misstatements and non-compliance with internal control requirements. This could also affect the Clinic’s financial integrity and accountability. Context: The approval for payroll processing was missing for one out of five payroll periods tested. Cause: The established pre-approval process was inadvertently bypassed by the payroll department staff. Recommendation: We recommend the implementation of a mandatory approval feature within the payroll system that requires sign-off by the CEO or CFO before payroll can be processed. Additionally, training should be provided to all payroll staff on the importance of adhering to internal control policies. Regular audits of payroll approvals should also be instituted to ensure compliance with the policy. Management Response: See Corrective Action Plan.
Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we noted instances where no supporting eligibility application and income verification were maintained by Community Health Partners, Inc. (the Clinic) to support the sliding fee scale discount adjustment that the patient received. Criteria: The sliding fee scale discount is based on patient income and demographic information. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in improper client billing and loss of revenue. Context: The Clinic did not maintain an eligibility application and income verification for 3 out of 40 patients tested. Cause: The Clinic had no form of secondary review in place, resulting in the errors in improper documentation not being detected and corrected in a timely manner. Recommendation: We recommend a secondary review of the applications and system input to ensure the proper documentation is verified in the electronic health records to support the slide eligibility. Management response: See Corrective Action Plan.
Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures over the UDS report, it was identified that the number of visits reported for physicians was overstated, while those for Nurse Practitioners (NPs) were understated. This discrepancy was due to a system error that incorrectly classified NPs as physicians. Criteria: Accurate reporting of service utilization by specific provider types is crucial for compliance with Department of Health and Human Services guidelines. Effect: Misclassification could lead to non-compliance with grant reporting requirements, potentially affecting the Clinic’s funding and accuracy of statistical data used for healthcare planning and resource allocation. Context: An analysis of visit data revealed that a system coding error led to incorrect provider type attribution where several NPs were recorded as physicians. Cause: Review of the report detected the error but it was not corrected in the final submission. Recommendation: We recommend an immediate review and correction of the errors noted in the accuracy report be completed prior to submission. Management Response: See Corrective Action Plan.
Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we noted an instance that payroll was processed without prior approval from the Chief Executive Officer (CEO) or Chief financial Officer (CFO), which is a violation of the Clinic's internal control policies. Criteria: The Clinic's internal control policies require that all payroll transactions be approved by either the CEO or the CFO before processing to ensure accuracy and compliance with budgetary allocations. Effect: The absence of proper approval could lead to unauthorized or erroneous payroll transactions, potentially resulting in financial misstatements and non-compliance with internal control requirements. This could also affect the Clinic’s financial integrity and accountability. Context: The approval for payroll processing was missing for one out of five payroll periods tested. Cause: The established pre-approval process was inadvertently bypassed by the payroll department staff. Recommendation: We recommend the implementation of a mandatory approval feature within the payroll system that requires sign-off by the CEO or CFO before payroll can be processed. Additionally, training should be provided to all payroll staff on the importance of adhering to internal control policies. Regular audits of payroll approvals should also be instituted to ensure compliance with the policy. Management Response: See Corrective Action Plan.
Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we noted instances where no supporting eligibility application and income verification were maintained by Community Health Partners, Inc. (the Clinic) to support the sliding fee scale discount adjustment that the patient received. Criteria: The sliding fee scale discount is based on patient income and demographic information. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in improper client billing and loss of revenue. Context: The Clinic did not maintain an eligibility application and income verification for 3 out of 40 patients tested. Cause: The Clinic had no form of secondary review in place, resulting in the errors in improper documentation not being detected and corrected in a timely manner. Recommendation: We recommend a secondary review of the applications and system input to ensure the proper documentation is verified in the electronic health records to support the slide eligibility. Management response: See Corrective Action Plan.
Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures over the UDS report, it was identified that the number of visits reported for physicians was overstated, while those for Nurse Practitioners (NPs) were understated. This discrepancy was due to a system error that incorrectly classified NPs as physicians. Criteria: Accurate reporting of service utilization by specific provider types is crucial for compliance with Department of Health and Human Services guidelines. Effect: Misclassification could lead to non-compliance with grant reporting requirements, potentially affecting the Clinic’s funding and accuracy of statistical data used for healthcare planning and resource allocation. Context: An analysis of visit data revealed that a system coding error led to incorrect provider type attribution where several NPs were recorded as physicians. Cause: Review of the report detected the error but it was not corrected in the final submission. Recommendation: We recommend an immediate review and correction of the errors noted in the accuracy report be completed prior to submission. Management Response: See Corrective Action Plan.
Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we noted an instance that payroll was processed without prior approval from the Chief Executive Officer (CEO) or Chief financial Officer (CFO), which is a violation of the Clinic's internal control policies. Criteria: The Clinic's internal control policies require that all payroll transactions be approved by either the CEO or the CFO before processing to ensure accuracy and compliance with budgetary allocations. Effect: The absence of proper approval could lead to unauthorized or erroneous payroll transactions, potentially resulting in financial misstatements and non-compliance with internal control requirements. This could also affect the Clinic’s financial integrity and accountability. Context: The approval for payroll processing was missing for one out of five payroll periods tested. Cause: The established pre-approval process was inadvertently bypassed by the payroll department staff. Recommendation: We recommend the implementation of a mandatory approval feature within the payroll system that requires sign-off by the CEO or CFO before payroll can be processed. Additionally, training should be provided to all payroll staff on the importance of adhering to internal control policies. Regular audits of payroll approvals should also be instituted to ensure compliance with the policy. Management Response: See Corrective Action Plan.