Audit 391649

Information on the federal program – Assistance Listing Number 93.224/93.527, Health Center Program Cluster, Department of Health and Human Services, Federal Award No. 5 H80CS33656 for project period May 1, 2023 through April 30, 2024. Criteria or specific requirement – Health centers must comply with federal reporting requirements as required under the HCP authorized by section 330 of the Public Health Service (PHS) Act (42 U.S.C. 254b). Condition – The Center did not have data to support certain line items reported on the Uniform Data System (UDS) report filed. Within Table 5 of the UDS report, the amounts reported within line 8, column B2 and line 10A, column B2, were not supportable by underlying data. Within Table 8A of the UDS report, the amounts reported within line 17 column C, line 1, column C, and line 3, column C, were not supportable by underlying data. Cause – Internal controls were not in place to ensure proper supporting documentation was retained along with the submitted Uniform Data System report. Effect or potential effect – Inaccurate filing of reports may result in the federal program not being properly monitored, thus resulting in potential noncompliance with program requirements. Questioned costs – None Context – Only 1 special report was required to be submitted during the year under audit (UDS). Identification as a repeat finding, if applicable – Not a repeat finding Recommendation – We recommend management implement an additional level of review by someone with knowledge of the reporting requirements. Views of responsible officials and planned corrective actions – Management acknowledged a lack of document retention resulted in the final calculation not being saved in a central, shared site that would support the amount filed. In future periods, management will have processes and procedures in place to require reconciliation and tie-out of supporting documentation to final filings which will alleviate this finding.

Information on the federal program – Assistance Listing Number 93.224/93.527, Health Center Program Cluster, Department of Health and Human Services, Federal Award No. 5 H80CS33656 for project period May 1, 2023 through April 30, 2024 and Federal Award No. 6 H80CS33656 for project period May 1, 2024 through April 30, 2025. 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 (discounted) based on the patient’s ability to pay ((42 USC 254b(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g); and 42 CFR sections 56.303(e), (f), and (g)). Condition – During our review of the Center’s sliding fee calculations, we noted 4 patient accounts with incorrectly calculated sliding fee adjustments. Cause – The Center did not have internal controls in place to ensure that the correct sliding fee adjustment was applied to patient accounts. Effect or potential effect – Patients received incorrect sliding fee adjustments resulting in an incorrect patient responsibility. Questioned costs – None Context – Out of a population of 106 patient accounts receiving sliding fee adjustments, a sample of 11 patient accounts were selected for testing, and 4 accounts had an incorrect sliding fee adjustment calculation. The sample was not statistically valid. Identification as a repeat finding, if applicable – Not a repeat finding Recommendation – We recommend the Center establish an internal control procedure to ensure that sliding fee adjustments are correctly calculated and reviewed. Views of responsible officials and planned corrective actions – Management acknowledged the sliding fee adjustment errors resulted from incorrect calculation of sliding fee discount. Management will add an additional layer of review over the application of the sliding fee scale. Further, the Center will implement a process to periodically review sliding fee adjustments throughout the year for accuracy.