Audit 338738

FY End
2024-03-31
Total Expended
$6.88M
Findings
6
Programs
6
Year: 2024 Accepted: 2025-01-17

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
519666 2024-001 Significant Deficiency - N
519667 2024-001 Significant Deficiency - N
519668 2024-001 Significant Deficiency - N
1096108 2024-001 Significant Deficiency - N
1096109 2024-001 Significant Deficiency - N
1096110 2024-001 Significant Deficiency - N

Contacts

Name Title Type
NWHUZ1PYN9B7 Karin Cooney Auditee
2319471112 Robert Friske Auditor
No contacts on file

Notes to SEFA

Title: U.S. Department of Agriculture Loan Agreement Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards includes the federal grant activity of Northwest Michigan Health Services, Inc. and is presented using the accrual basis of accounting. The information in this schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. The expenditures in the Schedule of Expenditures of Federal Awards are in agreement with the amounts reported in the financial statements and reports submitted to the Department of Health and Human Services. Although some grant awards are for different periods than the Center's fiscal year, all expenditures in the schedule are for the year ended March 31, 2024. De Minimis Rate Used: N Rate Explanation: Northwest Michigan Health Services, Inc. has not elected to use the 10% de minimus indirect costs rate. The amount expended under AL 10.766, Community Facilities Loans and Grants, represents the beginning loan of a U.S. Department of Agriculture loan agreement. The loan had an outstanding principal balance of $707,066 as of March 31, 2024.
Title: Reconciliation of Federal Awards Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards includes the federal grant activity of Northwest Michigan Health Services, Inc. and is presented using the accrual basis of accounting. The information in this schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. The expenditures in the Schedule of Expenditures of Federal Awards are in agreement with the amounts reported in the financial statements and reports submitted to the Department of Health and Human Services. Although some grant awards are for different periods than the Center's fiscal year, all expenditures in the schedule are for the year ended March 31, 2024. De Minimis Rate Used: N Rate Explanation: Northwest Michigan Health Services, Inc. has not elected to use the 10% de minimus indirect costs rate. Federal awards revenue for the year ended March 31, 2024 is reported as follows: Expenditures per schedule of expenditures of federal awards $6,883,170. Provider Relief Funds (AL# 93.498) - Revenue in prior year on the statement of activities, reported on current year schedule of expenditures of federal awards. $(996,244). Community Facilities Loans and Grants (AL# 10.766) - Represents the beginning loan balance of loan agreement with U.S. Department of Agriculture. $(750,707). Federal grants per statement of activities. $5,136,219.

Finding Details

Criteria - Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5) and 56.303(f)). The Center should be implementing and monitoring procedures to properly determine, calculate, and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Condition - During audit procedures of sliding fee adjustments there were multiple instances where the slide was inappropriately applied based on the sliding fee discount schedule in place at the time of service and multiple applications were missing. Questioned Costs - None. Context- A nonstatistical sample of 40 sliding fee adjustment transactions were selected for testing. Of this sample two errors were identified as incorrect sliding fee was given to the patient, one sliding fee application was missing from the client's records, and one sliding fee inputs did not agree to the application on file. Potential Effect - The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended March 31, 2024. In addition, the Center did not comply with its policies and procedures and may have not properly calculated the sliding fee or discount given to the patients and the discount given, in any, may not have been based on the patient's ability to pay. Cause - The condition is attributable to human error and the lack of internal controls to monitor and review to ensure that the proper sliding fee documentation is being collected and applied. Recommendation - We recommend the Center provide proper training to employees to ensure that the sliding fee discounts are being properly applied and documented. In addition to implementing policies and procedures to ensure the sliding fee discounts are being properly monitored and supervised on a periodic basis to ensure compliance. Views of Responsible Officials and Planned Corrective Actions - Management concurs with this finding and will ensure that controls are established to ensure proper training and monitoring of the sliding fee discounts.
Criteria - Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5) and 56.303(f)). The Center should be implementing and monitoring procedures to properly determine, calculate, and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Condition - During audit procedures of sliding fee adjustments there were multiple instances where the slide was inappropriately applied based on the sliding fee discount schedule in place at the time of service and multiple applications were missing. Questioned Costs - None. Context- A nonstatistical sample of 40 sliding fee adjustment transactions were selected for testing. Of this sample two errors were identified as incorrect sliding fee was given to the patient, one sliding fee application was missing from the client's records, and one sliding fee inputs did not agree to the application on file. Potential Effect - The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended March 31, 2024. In addition, the Center did not comply with its policies and procedures and may have not properly calculated the sliding fee or discount given to the patients and the discount given, in any, may not have been based on the patient's ability to pay. Cause - The condition is attributable to human error and the lack of internal controls to monitor and review to ensure that the proper sliding fee documentation is being collected and applied. Recommendation - We recommend the Center provide proper training to employees to ensure that the sliding fee discounts are being properly applied and documented. In addition to implementing policies and procedures to ensure the sliding fee discounts are being properly monitored and supervised on a periodic basis to ensure compliance. Views of Responsible Officials and Planned Corrective Actions - Management concurs with this finding and will ensure that controls are established to ensure proper training and monitoring of the sliding fee discounts.
Criteria - Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5) and 56.303(f)). The Center should be implementing and monitoring procedures to properly determine, calculate, and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Condition - During audit procedures of sliding fee adjustments there were multiple instances where the slide was inappropriately applied based on the sliding fee discount schedule in place at the time of service and multiple applications were missing. Questioned Costs - None. Context- A nonstatistical sample of 40 sliding fee adjustment transactions were selected for testing. Of this sample two errors were identified as incorrect sliding fee was given to the patient, one sliding fee application was missing from the client's records, and one sliding fee inputs did not agree to the application on file. Potential Effect - The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended March 31, 2024. In addition, the Center did not comply with its policies and procedures and may have not properly calculated the sliding fee or discount given to the patients and the discount given, in any, may not have been based on the patient's ability to pay. Cause - The condition is attributable to human error and the lack of internal controls to monitor and review to ensure that the proper sliding fee documentation is being collected and applied. Recommendation - We recommend the Center provide proper training to employees to ensure that the sliding fee discounts are being properly applied and documented. In addition to implementing policies and procedures to ensure the sliding fee discounts are being properly monitored and supervised on a periodic basis to ensure compliance. Views of Responsible Officials and Planned Corrective Actions - Management concurs with this finding and will ensure that controls are established to ensure proper training and monitoring of the sliding fee discounts.
Criteria - Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5) and 56.303(f)). The Center should be implementing and monitoring procedures to properly determine, calculate, and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Condition - During audit procedures of sliding fee adjustments there were multiple instances where the slide was inappropriately applied based on the sliding fee discount schedule in place at the time of service and multiple applications were missing. Questioned Costs - None. Context- A nonstatistical sample of 40 sliding fee adjustment transactions were selected for testing. Of this sample two errors were identified as incorrect sliding fee was given to the patient, one sliding fee application was missing from the client's records, and one sliding fee inputs did not agree to the application on file. Potential Effect - The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended March 31, 2024. In addition, the Center did not comply with its policies and procedures and may have not properly calculated the sliding fee or discount given to the patients and the discount given, in any, may not have been based on the patient's ability to pay. Cause - The condition is attributable to human error and the lack of internal controls to monitor and review to ensure that the proper sliding fee documentation is being collected and applied. Recommendation - We recommend the Center provide proper training to employees to ensure that the sliding fee discounts are being properly applied and documented. In addition to implementing policies and procedures to ensure the sliding fee discounts are being properly monitored and supervised on a periodic basis to ensure compliance. Views of Responsible Officials and Planned Corrective Actions - Management concurs with this finding and will ensure that controls are established to ensure proper training and monitoring of the sliding fee discounts.
Criteria - Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5) and 56.303(f)). The Center should be implementing and monitoring procedures to properly determine, calculate, and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Condition - During audit procedures of sliding fee adjustments there were multiple instances where the slide was inappropriately applied based on the sliding fee discount schedule in place at the time of service and multiple applications were missing. Questioned Costs - None. Context- A nonstatistical sample of 40 sliding fee adjustment transactions were selected for testing. Of this sample two errors were identified as incorrect sliding fee was given to the patient, one sliding fee application was missing from the client's records, and one sliding fee inputs did not agree to the application on file. Potential Effect - The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended March 31, 2024. In addition, the Center did not comply with its policies and procedures and may have not properly calculated the sliding fee or discount given to the patients and the discount given, in any, may not have been based on the patient's ability to pay. Cause - The condition is attributable to human error and the lack of internal controls to monitor and review to ensure that the proper sliding fee documentation is being collected and applied. Recommendation - We recommend the Center provide proper training to employees to ensure that the sliding fee discounts are being properly applied and documented. In addition to implementing policies and procedures to ensure the sliding fee discounts are being properly monitored and supervised on a periodic basis to ensure compliance. Views of Responsible Officials and Planned Corrective Actions - Management concurs with this finding and will ensure that controls are established to ensure proper training and monitoring of the sliding fee discounts.
Criteria - Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5) and 56.303(f)). The Center should be implementing and monitoring procedures to properly determine, calculate, and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Condition - During audit procedures of sliding fee adjustments there were multiple instances where the slide was inappropriately applied based on the sliding fee discount schedule in place at the time of service and multiple applications were missing. Questioned Costs - None. Context- A nonstatistical sample of 40 sliding fee adjustment transactions were selected for testing. Of this sample two errors were identified as incorrect sliding fee was given to the patient, one sliding fee application was missing from the client's records, and one sliding fee inputs did not agree to the application on file. Potential Effect - The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended March 31, 2024. In addition, the Center did not comply with its policies and procedures and may have not properly calculated the sliding fee or discount given to the patients and the discount given, in any, may not have been based on the patient's ability to pay. Cause - The condition is attributable to human error and the lack of internal controls to monitor and review to ensure that the proper sliding fee documentation is being collected and applied. Recommendation - We recommend the Center provide proper training to employees to ensure that the sliding fee discounts are being properly applied and documented. In addition to implementing policies and procedures to ensure the sliding fee discounts are being properly monitored and supervised on a periodic basis to ensure compliance. Views of Responsible Officials and Planned Corrective Actions - Management concurs with this finding and will ensure that controls are established to ensure proper training and monitoring of the sliding fee discounts.