Audit 390525

Finding Number: 2024-002 Finding Type: Noncompliance Information on the Federal Program: N/A – Not program-specific Criteria: 2 CFR Section 200.512(a) requires the reporting package and data collection form to be submitted to the Federal Audit Clearinghouse (FAC) the earlier of 30 calendar days after the reports are received from the auditor or nine months after the end of the audit period. Condition: FAC filing for fiscal year ended March 31, 2024 was submitted late. Cause: The Organization did not have effective internal controls to ensure timely and accurate preparation of financial information, including account reconciliations (see Finding 2024.001). As a result, management did not have the information necessary to complete the FAC filing within the timeframe required by 2 CFR §200.520(a). Effect: The late submission of the Single Audit report to the Federal Audit Clearinghouse creates noncompliance with federal reporting requirements and increases the Organization’s risk of administrative actions by federal awarding agencies, including Health Resources and Services Administration (HRSA). This may result in delayed acceptance of federal awards, imposition of grant conditions, or restrictions on access to federal funds until the report is submitted and accepted. Questioned Costs: None Repeat Finding: Yes, 2023-002 Recommendation: The Organization should implement procedures to ensure that account reconciliations and financial reporting are completed in a timely manner, enabling the Single Audit reporting package to be submitted to the Federal Audit Clearinghouse within the required timeframe. Views of a Responsible Official and Corrective Action Plan: Management agrees with the finding. The Organization is implementing procedures to complete and review account reconciliations and financial reporting on a monthly basis, with appropriate oversight and staffing. These steps are intended to ensure that future Single Audit reporting packages are submitted to the Federal Audit Clearinghouse within the required timeframe.

Finding Number: 2024-003 Finding Type: Significant Deficiency in Internal Controls Over Compliance related to Special Tests and Provisions Information on the Federal Program: Program Name: Health Center Program Cluster (93.527) Grant Award: 5 H80CS00802-22 Budget Period: April 1, 2023 through March 31, 2024 Agency: U.S. Department of Health and Human Services, Health Resources and Services Administration Pass Through Entity: N/A Criteria: In accordance with Section 330(k)(3)(G) of the Public Health Services Act (42 U.S. Code § 254b), as an FQHC, the Organization must have a sliding fee discount program in which patient charges are adjusted based on the patient’s ability to pay. Condition: Through testing a statistically valid sample of 25 individual patient balances, we noted one instance in which the sliding fee discount applied was inconsistent with the Organization’s policy. Based on income and family size, the patient received a discount of $115 but qualified for a discount of $215, resulting in a $100 difference. Cause: The application of sliding fee discounts to patient accounts involves manual processes, which are inherently susceptible to errors. The Organization does not currently have a formal monitoring process or policy to ensure discounts are applied correctly, which increases the risk that errors may occur and go undetected. Effect: It is possible that sliding fee discounts may not be applied consistently across all patient accounts, and errors may not be identified and corrected in a timely manner, which could result in noncompliance with the Organization’s sliding fee discount program and federal program requirements. Questioned Costs: None Repeat Finding: No Recommendation: The Organization should establish a formal procedure to monitor compliance with its sliding fee discount program. The procedure should assign responsibility for reviewing applied discounts, define the frequency and sample size of reviews, and include consideration for differences between the Medical and Dental systems, with a larger or more frequent sample for Dental due to higher manual processing and volume. The procedure should also include steps to document and correct any errors identified and require supervisory oversight to verify that reviews are performed consistently. Implementing this procedure will help ensure discounts are applied accurately and in accordance with the Organization’s policy and federal requirements. Views of a Responsible Official and Corrective Action Plan: Management agrees with the finding and will develop and implement the recommendations above.