Audit 340762

FY End
2024-08-31
Total Expended
$4.58M
Findings
8
Programs
22
Year: 2024 Accepted: 2025-01-31
Auditor: Scheffel Boyle

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
520890 2024-001 Significant Deficiency Yes N
520891 2024-001 Significant Deficiency Yes N
520892 2024-001 Significant Deficiency Yes N
520893 2024-001 Significant Deficiency Yes N
1097332 2024-001 Significant Deficiency Yes N
1097333 2024-001 Significant Deficiency Yes N
1097334 2024-001 Significant Deficiency Yes N
1097335 2024-001 Significant Deficiency Yes N

Programs

ALN Program Spent Major Findings
93.224 Community Health Centers $288,906 Yes 1
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $203,044 - 0
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $198,873 Yes 1
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $176,129 - 0
93.967 Centers for Disease Control and Prevention Collaboration with Academia to Strengthen Public Health $154,170 - 0
93.959 Block Grants for Prevention and Treatment of Substance Abuse $125,553 - 0
20.509 Formula Grants for Rural Areas and Tribal Transit Program $119,868 - 0
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $116,851 - 0
93.332 Cooperative Agreement to Support Navigators in Federally-Facilitated Exchanges $57,825 - 0
21.027 Coronavirus State and Local Fiscal Recovery Funds $34,938 - 0
93.526 Fip Verification $14,627 - 0
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $14,242 - 0
93.043 Special Programs for the Aging, Title Iii, Part D, Disease Prevention and Health Promotion Services $13,597 - 0
93.008 Medical Reserve Corps Small Grant Program $11,821 - 0
93.069 Public Health Emergency Preparedness $8,120 - 0
16.575 Crime Victim Assistance $7,785 - 0
93.994 Maternal and Child Health Services Block Grant to the States $7,070 - 0
93.268 Immunization Cooperative Agreements $6,061 - 0
66.032 State Indoor Radon Grants $3,826 - 0
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $2,920 - 0
93.071 Medicare Enrollment Assistance Program $1,261 - 0
66.605 Performance Partnership Grants $67 - 0

Contacts

Name Title Type
E6GNFKXLYG39 Christy Blank Auditee
2178543223 Daniel Phipps Auditor
No contacts on file

Notes to SEFA

Title: BASIS OF PRESENTATION Accounting Policies: Federal awards are accounted for using the accrual basis of accounting. The Schedule reflects the accrual basis of accounting in which revenues are recognized when earned and expenditures are recognized when incurred. De Minimis Rate Used: Y Rate Explanation: The Health Department elected to use the 10% de minimis indirect cost rate. The accompanying Schedule of Expenditures of Federal Awards (the Schedule) summarizes the expenditures of Macoupin County Health Department under programs of the federal government for the fiscal year ended August 31, 2024. Because the Schedule presents only a selected portion of the operations of the Health Department, it is not intended to and does not present the financial position, changes in fund balance, revenues and expenditures of the Health Department. For purposes of the Schedule, federal awards include all grants, contracts and similar agreements entered into directly between the Health Department and agencies and departments of the federal government and all subawards to the Health Department by nonfederal organizations pursuant to federal grants, contracts and similar agreements. The schedule presents expenditures by federal agency for the Health Department's major and nonmajor programs in accordance with the provisions of the U.S. Office of Management and Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance).
Title: SUBRECIPIENTS Accounting Policies: Federal awards are accounted for using the accrual basis of accounting. The Schedule reflects the accrual basis of accounting in which revenues are recognized when earned and expenditures are recognized when incurred. De Minimis Rate Used: Y Rate Explanation: The Health Department elected to use the 10% de minimis indirect cost rate. The Health Department did not pass through any federal funds to subrecipients during the year ended August 31, 2024.
Title: NONMONETARY DISTRIBUTIONS Accounting Policies: Federal awards are accounted for using the accrual basis of accounting. The Schedule reflects the accrual basis of accounting in which revenues are recognized when earned and expenditures are recognized when incurred. De Minimis Rate Used: Y Rate Explanation: The Health Department elected to use the 10% de minimis indirect cost rate. The Health Department did not receive any nonmonetary distributions as it relates to federal programs for the year ended August 31, 2024.
Title: INSURANCE Accounting Policies: Federal awards are accounted for using the accrual basis of accounting. The Schedule reflects the accrual basis of accounting in which revenues are recognized when earned and expenditures are recognized when incurred. De Minimis Rate Used: Y Rate Explanation: The Health Department elected to use the 10% de minimis indirect cost rate. The Health Department had no insurance as it relates to federal programs in effect for the year ended August 31, 2024.
Title: LOANS AND LOAN GURANTEES Accounting Policies: Federal awards are accounted for using the accrual basis of accounting. The Schedule reflects the accrual basis of accounting in which revenues are recognized when earned and expenditures are recognized when incurred. De Minimis Rate Used: Y Rate Explanation: The Health Department elected to use the 10% de minimis indirect cost rate. The Health Department had no outstanding loans or loan guarantees from federal sources as of August 31, 2024.
Title: DONATED PERSONAL PROTECTIVE EQUIPMENT Accounting Policies: Federal awards are accounted for using the accrual basis of accounting. The Schedule reflects the accrual basis of accounting in which revenues are recognized when earned and expenditures are recognized when incurred. De Minimis Rate Used: Y Rate Explanation: The Health Department elected to use the 10% de minimis indirect cost rate. During the year ended August 31, 2024, the Health Department did not receive any donated personal protective equipment through federal funding.

Finding Details

Criteria or specific requirement: Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay as follows: a) Sliding fee discounts are applied to fees for health center services provided to all individuals and families with annual incomes at or below 200 percent of the Federal Poverty Guidelines (FPG); b) A full discount is applied to fees for health center services provided to individuals and families with annual incomes at or below 100 percent of the FPG, or the health center applies only a nominal charge; c) Fees for health center services are discounted based on gradations in family size and income for individuals and families with incomes above 100 and at or below 200 percent of the FPG; and d) No sliding fee discount is applied to fees for health center services provided to individuals and families with annual incomes above 200 percent of the FPG. Condition: During the compliance testing of the Uniform Guidance "Special Tests and Provisions - Sliding Fee Discounts" four (4) selections out of a sample size of forty (40) did not obtain proper proof of income prior to applying the sliding fee discount. In addition, four (4) selections out of a sample size of forty (40) used the incorrect calculation of income from the proof of income and applied the incorrect sliding fee. Questioned Costs: None. Effect: The patient was not charged the correct amount for the services that were performed based on income information provided or lack of income information. Cause: Lack of proof of income documentation and incorrect income amounts being used were due to oversight. Recommendation: Management should ensure that all information is input into the billing system correctly in order to avoid patients getting charged incorrect amounts for services. Management's Response: Management is implementing weekly chart auditing of encounters from the prior week. These reviews will include a review of the client's financial information which includes assessment of the sliding fee scale paperwork completed, whether we have obtained proof of income, if the sliding fee was entered into the billing system, if the sliding fee adjustments are applied, if payment was collected, insurance information, and the client's balance. These audits will be sent to front office staff for corrections (if needed) or the CFO for review on a monthly basis. In addition, MCPHC Supervisors will obtain a monthly report of the clients that have not turned in proof of income in order to proactively reach out either by phone, email or mail and attempt to obtain the information.
Criteria or specific requirement: Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay as follows: a) Sliding fee discounts are applied to fees for health center services provided to all individuals and families with annual incomes at or below 200 percent of the Federal Poverty Guidelines (FPG); b) A full discount is applied to fees for health center services provided to individuals and families with annual incomes at or below 100 percent of the FPG, or the health center applies only a nominal charge; c) Fees for health center services are discounted based on gradations in family size and income for individuals and families with incomes above 100 and at or below 200 percent of the FPG; and d) No sliding fee discount is applied to fees for health center services provided to individuals and families with annual incomes above 200 percent of the FPG. Condition: During the compliance testing of the Uniform Guidance "Special Tests and Provisions - Sliding Fee Discounts" four (4) selections out of a sample size of forty (40) did not obtain proper proof of income prior to applying the sliding fee discount. In addition, four (4) selections out of a sample size of forty (40) used the incorrect calculation of income from the proof of income and applied the incorrect sliding fee. Questioned Costs: None. Effect: The patient was not charged the correct amount for the services that were performed based on income information provided or lack of income information. Cause: Lack of proof of income documentation and incorrect income amounts being used were due to oversight. Recommendation: Management should ensure that all information is input into the billing system correctly in order to avoid patients getting charged incorrect amounts for services. Management's Response: Management is implementing weekly chart auditing of encounters from the prior week. These reviews will include a review of the client's financial information which includes assessment of the sliding fee scale paperwork completed, whether we have obtained proof of income, if the sliding fee was entered into the billing system, if the sliding fee adjustments are applied, if payment was collected, insurance information, and the client's balance. These audits will be sent to front office staff for corrections (if needed) or the CFO for review on a monthly basis. In addition, MCPHC Supervisors will obtain a monthly report of the clients that have not turned in proof of income in order to proactively reach out either by phone, email or mail and attempt to obtain the information.
Criteria or specific requirement: Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay as follows: a) Sliding fee discounts are applied to fees for health center services provided to all individuals and families with annual incomes at or below 200 percent of the Federal Poverty Guidelines (FPG); b) A full discount is applied to fees for health center services provided to individuals and families with annual incomes at or below 100 percent of the FPG, or the health center applies only a nominal charge; c) Fees for health center services are discounted based on gradations in family size and income for individuals and families with incomes above 100 and at or below 200 percent of the FPG; and d) No sliding fee discount is applied to fees for health center services provided to individuals and families with annual incomes above 200 percent of the FPG. Condition: During the compliance testing of the Uniform Guidance "Special Tests and Provisions - Sliding Fee Discounts" four (4) selections out of a sample size of forty (40) did not obtain proper proof of income prior to applying the sliding fee discount. In addition, four (4) selections out of a sample size of forty (40) used the incorrect calculation of income from the proof of income and applied the incorrect sliding fee. Questioned Costs: None. Effect: The patient was not charged the correct amount for the services that were performed based on income information provided or lack of income information. Cause: Lack of proof of income documentation and incorrect income amounts being used were due to oversight. Recommendation: Management should ensure that all information is input into the billing system correctly in order to avoid patients getting charged incorrect amounts for services. Management's Response: Management is implementing weekly chart auditing of encounters from the prior week. These reviews will include a review of the client's financial information which includes assessment of the sliding fee scale paperwork completed, whether we have obtained proof of income, if the sliding fee was entered into the billing system, if the sliding fee adjustments are applied, if payment was collected, insurance information, and the client's balance. These audits will be sent to front office staff for corrections (if needed) or the CFO for review on a monthly basis. In addition, MCPHC Supervisors will obtain a monthly report of the clients that have not turned in proof of income in order to proactively reach out either by phone, email or mail and attempt to obtain the information.
Criteria or specific requirement: Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay as follows: a) Sliding fee discounts are applied to fees for health center services provided to all individuals and families with annual incomes at or below 200 percent of the Federal Poverty Guidelines (FPG); b) A full discount is applied to fees for health center services provided to individuals and families with annual incomes at or below 100 percent of the FPG, or the health center applies only a nominal charge; c) Fees for health center services are discounted based on gradations in family size and income for individuals and families with incomes above 100 and at or below 200 percent of the FPG; and d) No sliding fee discount is applied to fees for health center services provided to individuals and families with annual incomes above 200 percent of the FPG. Condition: During the compliance testing of the Uniform Guidance "Special Tests and Provisions - Sliding Fee Discounts" four (4) selections out of a sample size of forty (40) did not obtain proper proof of income prior to applying the sliding fee discount. In addition, four (4) selections out of a sample size of forty (40) used the incorrect calculation of income from the proof of income and applied the incorrect sliding fee. Questioned Costs: None. Effect: The patient was not charged the correct amount for the services that were performed based on income information provided or lack of income information. Cause: Lack of proof of income documentation and incorrect income amounts being used were due to oversight. Recommendation: Management should ensure that all information is input into the billing system correctly in order to avoid patients getting charged incorrect amounts for services. Management's Response: Management is implementing weekly chart auditing of encounters from the prior week. These reviews will include a review of the client's financial information which includes assessment of the sliding fee scale paperwork completed, whether we have obtained proof of income, if the sliding fee was entered into the billing system, if the sliding fee adjustments are applied, if payment was collected, insurance information, and the client's balance. These audits will be sent to front office staff for corrections (if needed) or the CFO for review on a monthly basis. In addition, MCPHC Supervisors will obtain a monthly report of the clients that have not turned in proof of income in order to proactively reach out either by phone, email or mail and attempt to obtain the information.
Criteria or specific requirement: Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay as follows: a) Sliding fee discounts are applied to fees for health center services provided to all individuals and families with annual incomes at or below 200 percent of the Federal Poverty Guidelines (FPG); b) A full discount is applied to fees for health center services provided to individuals and families with annual incomes at or below 100 percent of the FPG, or the health center applies only a nominal charge; c) Fees for health center services are discounted based on gradations in family size and income for individuals and families with incomes above 100 and at or below 200 percent of the FPG; and d) No sliding fee discount is applied to fees for health center services provided to individuals and families with annual incomes above 200 percent of the FPG. Condition: During the compliance testing of the Uniform Guidance "Special Tests and Provisions - Sliding Fee Discounts" four (4) selections out of a sample size of forty (40) did not obtain proper proof of income prior to applying the sliding fee discount. In addition, four (4) selections out of a sample size of forty (40) used the incorrect calculation of income from the proof of income and applied the incorrect sliding fee. Questioned Costs: None. Effect: The patient was not charged the correct amount for the services that were performed based on income information provided or lack of income information. Cause: Lack of proof of income documentation and incorrect income amounts being used were due to oversight. Recommendation: Management should ensure that all information is input into the billing system correctly in order to avoid patients getting charged incorrect amounts for services. Management's Response: Management is implementing weekly chart auditing of encounters from the prior week. These reviews will include a review of the client's financial information which includes assessment of the sliding fee scale paperwork completed, whether we have obtained proof of income, if the sliding fee was entered into the billing system, if the sliding fee adjustments are applied, if payment was collected, insurance information, and the client's balance. These audits will be sent to front office staff for corrections (if needed) or the CFO for review on a monthly basis. In addition, MCPHC Supervisors will obtain a monthly report of the clients that have not turned in proof of income in order to proactively reach out either by phone, email or mail and attempt to obtain the information.
Criteria or specific requirement: Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay as follows: a) Sliding fee discounts are applied to fees for health center services provided to all individuals and families with annual incomes at or below 200 percent of the Federal Poverty Guidelines (FPG); b) A full discount is applied to fees for health center services provided to individuals and families with annual incomes at or below 100 percent of the FPG, or the health center applies only a nominal charge; c) Fees for health center services are discounted based on gradations in family size and income for individuals and families with incomes above 100 and at or below 200 percent of the FPG; and d) No sliding fee discount is applied to fees for health center services provided to individuals and families with annual incomes above 200 percent of the FPG. Condition: During the compliance testing of the Uniform Guidance "Special Tests and Provisions - Sliding Fee Discounts" four (4) selections out of a sample size of forty (40) did not obtain proper proof of income prior to applying the sliding fee discount. In addition, four (4) selections out of a sample size of forty (40) used the incorrect calculation of income from the proof of income and applied the incorrect sliding fee. Questioned Costs: None. Effect: The patient was not charged the correct amount for the services that were performed based on income information provided or lack of income information. Cause: Lack of proof of income documentation and incorrect income amounts being used were due to oversight. Recommendation: Management should ensure that all information is input into the billing system correctly in order to avoid patients getting charged incorrect amounts for services. Management's Response: Management is implementing weekly chart auditing of encounters from the prior week. These reviews will include a review of the client's financial information which includes assessment of the sliding fee scale paperwork completed, whether we have obtained proof of income, if the sliding fee was entered into the billing system, if the sliding fee adjustments are applied, if payment was collected, insurance information, and the client's balance. These audits will be sent to front office staff for corrections (if needed) or the CFO for review on a monthly basis. In addition, MCPHC Supervisors will obtain a monthly report of the clients that have not turned in proof of income in order to proactively reach out either by phone, email or mail and attempt to obtain the information.
Criteria or specific requirement: Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay as follows: a) Sliding fee discounts are applied to fees for health center services provided to all individuals and families with annual incomes at or below 200 percent of the Federal Poverty Guidelines (FPG); b) A full discount is applied to fees for health center services provided to individuals and families with annual incomes at or below 100 percent of the FPG, or the health center applies only a nominal charge; c) Fees for health center services are discounted based on gradations in family size and income for individuals and families with incomes above 100 and at or below 200 percent of the FPG; and d) No sliding fee discount is applied to fees for health center services provided to individuals and families with annual incomes above 200 percent of the FPG. Condition: During the compliance testing of the Uniform Guidance "Special Tests and Provisions - Sliding Fee Discounts" four (4) selections out of a sample size of forty (40) did not obtain proper proof of income prior to applying the sliding fee discount. In addition, four (4) selections out of a sample size of forty (40) used the incorrect calculation of income from the proof of income and applied the incorrect sliding fee. Questioned Costs: None. Effect: The patient was not charged the correct amount for the services that were performed based on income information provided or lack of income information. Cause: Lack of proof of income documentation and incorrect income amounts being used were due to oversight. Recommendation: Management should ensure that all information is input into the billing system correctly in order to avoid patients getting charged incorrect amounts for services. Management's Response: Management is implementing weekly chart auditing of encounters from the prior week. These reviews will include a review of the client's financial information which includes assessment of the sliding fee scale paperwork completed, whether we have obtained proof of income, if the sliding fee was entered into the billing system, if the sliding fee adjustments are applied, if payment was collected, insurance information, and the client's balance. These audits will be sent to front office staff for corrections (if needed) or the CFO for review on a monthly basis. In addition, MCPHC Supervisors will obtain a monthly report of the clients that have not turned in proof of income in order to proactively reach out either by phone, email or mail and attempt to obtain the information.
Criteria or specific requirement: Health Centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted based on the patient's ability to pay as follows: a) Sliding fee discounts are applied to fees for health center services provided to all individuals and families with annual incomes at or below 200 percent of the Federal Poverty Guidelines (FPG); b) A full discount is applied to fees for health center services provided to individuals and families with annual incomes at or below 100 percent of the FPG, or the health center applies only a nominal charge; c) Fees for health center services are discounted based on gradations in family size and income for individuals and families with incomes above 100 and at or below 200 percent of the FPG; and d) No sliding fee discount is applied to fees for health center services provided to individuals and families with annual incomes above 200 percent of the FPG. Condition: During the compliance testing of the Uniform Guidance "Special Tests and Provisions - Sliding Fee Discounts" four (4) selections out of a sample size of forty (40) did not obtain proper proof of income prior to applying the sliding fee discount. In addition, four (4) selections out of a sample size of forty (40) used the incorrect calculation of income from the proof of income and applied the incorrect sliding fee. Questioned Costs: None. Effect: The patient was not charged the correct amount for the services that were performed based on income information provided or lack of income information. Cause: Lack of proof of income documentation and incorrect income amounts being used were due to oversight. Recommendation: Management should ensure that all information is input into the billing system correctly in order to avoid patients getting charged incorrect amounts for services. Management's Response: Management is implementing weekly chart auditing of encounters from the prior week. These reviews will include a review of the client's financial information which includes assessment of the sliding fee scale paperwork completed, whether we have obtained proof of income, if the sliding fee was entered into the billing system, if the sliding fee adjustments are applied, if payment was collected, insurance information, and the client's balance. These audits will be sent to front office staff for corrections (if needed) or the CFO for review on a monthly basis. In addition, MCPHC Supervisors will obtain a monthly report of the clients that have not turned in proof of income in order to proactively reach out either by phone, email or mail and attempt to obtain the information.