Audit 394933

2025-001 – Significant Deficiency in Internal Control Over Compliance - Sliding Fee Discount Determination Condition: The Health Center determines patient's sliding fee discount levels based on eligibility. During our testing, we noted instances in which encounters eligible for sliding fee adjustments were not discounted in accordance with the approved sliding fee discount levels. Criteria: Special Tests and Provisions — 42 CFR Part 254b(k)(3)(F), and (G) and 51c.303(f), and (g) requires Health Centers receiving funds under the Health Center Program Cluster to prepare and maintain a fee schedule designed to recover reasonable operating costs, implement a corresponding sliding fee discount schedule based on patient's ability to pay, and maintain systems for eligibility determination, billing, and collection to ensure that patient payments for services are collected in accordance with the schedules of fees and discounts. Context: During our testing of sliding fee discounts for Health Center patients qualifying for reduced-charge visits, we identified three visits out of a sample of fifteen that received an incorrect sliding fee discount. Based on these findings, additional testing was not conducted. Cause: Internal control processes and procedures were not followed, resulting in discounts applied in the billing system that did not align with the sliding fee determinations approved per the patient applications. Effect: Sliding fee discounts were given to patients that were inconsistent with the RRHC's sliding fee discount policy. Auditor's Recommendation: We recommend that management implement a second-level, independent review of demographic and income verification information entered into the patient billing system. This review should ensure that sliding fee discounts are correctly applied in accordance with approved patient eligibility levels. Additionally, staff training and system controls should be strengthened to prevent recurrence.

2025-002 – Internal Control Over Compliance, Material Noncompliance - Procurement and Suspension and Debarment (Material Weakness) Condition: During our compliance testing, we observed that RRHC was unable to provide documentation confirming that the selected vendors were not suspended or debarred, and that proper bidding procedures were followed for federal expenditures. Criteria: Procurement 45 CFR 75.329 and 45 CFR 75.213. Context: During testing of two selected procurement samples, RRHC did not provide required supporting documents, including the solicitation like RFP, bid evaluation records, suspension/debarment verification, and evidence of public advertisement. Cause: Procedures were not in place or not effectively followed to ensure required procurement documentation was retained and available for audit. Effect: RRHC was unable to demonstrate compliance with federal procurement and suspension and debarment requirements. Auditor's Recommendation: Implement procedures to ensure that complete procurement documentation, including solicitation documents, bid evaluations, debarment checks, and advertisement evidence, is obtained, retained, and readily available for audit.