Audit 387012

Special Tests and Provisions – Sliding Fee Discounts – Significant Deficiency Grantor U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless and Public Housing Primary Care) Grants for New and Expanded Services Under the Health Center Program COVID-19 Grants for New and Expanded Services Under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Federal Award Identification Number and Year: H8000814 2025 and 2024, H8L51682 - 2024 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), 56.108(b)(5) and 56.303(f)). Kalihi-Palama Health Center and Subsidiary should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with Kalihi-Palama Health Center and Subsidiary's sliding fee scale. Condition Kalihi-Palama Health Center and Subsidiary did not always calculate the proper sliding fee discount based on approved policies or have adequate documentation on file. Cause Kalihi-Palama Health Center and Subsidiary did not have adequate internal controls in place to effectively ensure that patients received the correct sliding fee discount and have adequate documentation on file. Effect or Potential Effect Kalihi-Palama Health Center and Subsidiary did not comply with the appropriate Special Tests and Provisions rules and regulations as per the Uniform Guidance in 2025. Questioned costs None. Context A test of 40 sliding fee discount transactions was performed and resulted in three instances of incorrect sliding fee calculations, resulting in incorrect fees charged to the patients for their services based on family size and income. Our sample was a statistically valid sample. Identification as a Repeat Finding This finding is not a repeat finding. Recommendation Kalihi-Palama Health Center and Subsidiary should establish a system of internal controls to ensure that all sliding fee discounts are properly calculated and supported based on family size and income. Views of Responsible Officials Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.

Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless and Public Housing Primary Care) Grants for New and Expanded Services Under the Health Center Program COVID-19 Grants for New and Expanded Services Under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Federal Award Identification Number and Year: H8000814 - 2025 and 2024, H8L51682 - 2024 Criteria In accordance with §200.213 and §180.300, General Procurement Standards, nonfederal entities cannot enter into awards, subawards, or contracts with certain parties that are debarred, suspended, or otherwise excluded from or ineligible for participation in federal assistance programs or activities. Condition Kalihi-Palama Health Center and Subsidiary did not have adequate evidence that they reviewed employees for suspension and debarment in accordance with the Uniform Guidance requirement Cause Kalihi-Palama Health Center and Subsidiary did not have adequate internal controls in place to illustrate a review for suspended or debarred employees. Effect or Potential Effect Kalihi-Palama Health Center and Subsidiary may have employees that have been suspended or debarred for doing business with the federal government. Questioned costs None. Context A test of twenty-five employees for suspension and debarment testing was performed and for all twenty-five employees tested, management did not provide adequate supporting documentation for the review and approval of each employee as to whether they haves been suspended or debarred. For two months, management could not provide proper support to show suspension and debarment procedures were performed. Identification as a Repeat Finding This finding is not a repeat finding. Recommendation Kalihi-Palama Health Center and Subsidiary should establish a system of internal controls to review employees in accordance with the Uniform Guidance requirements for suspension and debarment. These procedures should be reviewed with the appropriate staff to ensure compliance with requirements. Views of Responsible Officials Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.