Audit 394336

Item 2025-001 - Special Tests and Provisions - U.S. Department of Health and Human Services, Health Center Program Cluster (Assistance Listing Number 93.224/93.527) Notice of Award Number 6 H80CS00646-23-07, 2 H80CS00646-24-01, 1 H8LCS51923-01-00 for 2024 and 2025, 1 H8NCS54043-01-00 for 2025 - (Significant Deficiency) Criteria: US Code Title 42, The Public Health and Welfare Act, Section 254b requires health centers to prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted or discounted based on the patient's ability to pay. Waimanalo Health Center's policy requires that sliding fee discount be modified on an annual basis based on the federal poverty level after the board's approval. Statement of condition: During our audit, we noted that the Center did not properly determine the sliding fee discount for one eligible patient, based on information provided during the patient registration process. Cause: Improper determination and application of sliding fee discount based on the Center's eligibility criteria. Effect or Potential Effect: Failure to properly apply the sliding fee discount resulted in a patient being charged incorrectly. Questioned costs: None. Context: One out of sixty samples tested was incorrectly slid. Identification as a repeat finding: This is a repeat of prior year's finding (Finding 2024-004). Recommendation: We recommend that the Center provide training to all personnel involved in determining patients’ sliding fee discounts. In addition, we recommend that an internal audit of a sample of patient charts be conducted periodically to verify that sliding fee scale discounts or categories are properly and accurately determined based on the information provided by patients. Finally, we recommend that the results of such internal audits be formally documented. Management response: Management agrees with the finding and will be establishing policies and procedures and conducting training for all personnel involved in determining patients' sliding fee discounts to help ensure the accuracy of the process. Management will also implement an internal audit of a sample of patient charts and will ensure that such audits are properly documented.

Item 2025-002 - Procurement, Suspension and Debarment - U.S. Department of Health and Human Services, Health Center Program Cluster (Assistance Listing Number 93.224/93.527) Notice of Award Number 6 H80CS00646-23-07, 2 H80CS00646-24-01, 1 H8LCS51923-01-00 for 2024 and 2025, 1 H8NCS54043-01-00 for 2025 - (Significant Deficiency) Criteria: Recipients and subrecipients are subject to the procurement, suspension and debarment regulations implementing Executive Orders 12549 and 12689, as well as 2 CFR part 180. The regulations in 2 CFR part 180 restrict making Federal awards, subawards, and contracts with certain parties that are debarred, suspended, or otherwise excluded from receiving or participating in Federal awards. The Center's policy is to conduct a monthly exclusion search for all its employees and contractors and requires that all searches are documented within the personnel file in the Human Resource system. Statement of condition: During our audit, we noted that certain employees have no record of an exclusion search conducted during 2025. There were also certain employees for whom an exclusion search was not consistently conducted on a monthly basis. Cause: Inconsistent application of the internal control. Effect or Potential Effect: Failure in implementing the exclusion search raises the risk that salaries of employees who are suspended or debarred may be charged to the program. Questioned costs: None Context: Two out of sixty samples tested did not have any exclusion searches on file during 2025. Three out of sixty samples did not have exclusion searches done on a monthly basis in 2025. However, none of the sixty samples tested were found to be suspended or debarred. Identification as a repeat finding: This is a repeat of prior year's finding (Finding 2024-005). Recommendation: We recommend that the Center train its personnel in relation to the exclusion screening and proper documentation thereof and that the Center conduct regular reviews to ensure the completeness of exclusion search documentation. Management response: Management agrees with the finding and will be conducting training for its personnel to help ensure the accuracy, completeness and timeliness of exclusion searches.