Audit 408356

Federal Agency: U.S Department of Health and Human Services Federal Program Name: Health Center Program Cluster Assistance Listing Number: 93.224 and 93.527 Award Period: 03/1/24-02/28/27 Type of Finding: Significant Deficiency in Internal Control over Compliance and Compliance Criteria or specific requirement: Per 42 USC 254b(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e),(f), and (g); the health and 42 CFR sections 56.303(e), (f), and (g) a health center must establish and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition: Per La Pine Community Health Center’s sliding fee discount policy the determination of a patient’s eligibility for the program is determined based upon gross income. Context: During our testing of the sliding fee discount program, we identified six instances of 40 that were determined based upon a patient’s net income vs gross income. Cause: Process and procedures were not followed and the Organization’s internal control system failed to identify the wrong basis for program eligibility was used in the determination process. Effect: Potentially a patient would receive an incorrect determination and/or sliding fee discount. Recommendation: Management should review their sliding fee policy, refamiliarize personnel with the policy, and implement a secondary review process. Views of responsible officials: There is no disagreement with the audit finding.

Federal Agency: U.S Department of Health and Human Services Federal Program Name: Health Center Program Cluster Assistance Listing Number: 93.224 and 93.527 Award Period: 03/01/24-02/28/27 Federal Program Name: Congressionally Directed Spending for Construction Projects Assistance Listing Number: 93.493 Award Period: 09/03/23-09/29/26 Type of Finding: Significant Deficiency in Internal Control over Compliance Criteria or specific requirement: 2 CFR 200.303 requires that recipients and subrecipients receiving federal awards establish, document and maintain effective internal control over the federal awards that provides reasonable assurance that the recipient or subrecipient is managing the federal awards in compliance with federal statutes, regulations, and the terms and conditions of the federal awards. Condition: There is no formal process in place to review required reports prior to submission. Context: During our audit inquiries related to internal control, it was noted that the Organization is not practicing a key control of their internal control structure by reviewing reports prior to submission to the relevant granting authority. Cause: Following recent staff turnover, an internal policy was not maintained and/or adhered to. Effect: Potentially submitted reports may contain errors or provide misinformation. Recommendation: We recommend the organization review all required reports for accuracy prior to submission. Views of responsible officials: There is no disagreement with the audit finding.