Audit 408644

Health Center Program Cluster; CFDA No. 93.224 and 93.527; HHS; grant number H80CS28961; budget periods June 1, 2024, through May 31, 2025 and June 1, 2025 through May 31, 2026 Criteria or specific requirement: Special Tests and Provisions – 42 CFR, Part 56.303(e), (f), and (g). Health Centers receiving funds under the Health Center Program Cluster are required to prepare a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts adjusted on the basis of the patient’s ability to pay, to make every reasonable effort, including the establishment of systems for eligibility determination, billing and collection, and to secure from patient payments for services in accordance with the schedule of fees and discounts. Condition: We noted during our testing of compliance with federal awards that the Health Center did not properly apply the sliding fee discounts approved by the board of directors for 3 patients out of a sample of 23 patients for the year ended December 31, 2025. Cause: The patients did not have a sliding fee application on file. Effect or Potential Effect: Discounts were improperly applied to patient accounts. Questioned cost: None Context: From a total of 116 sliding fee discounts for the period, 23 discounts were selected for testing. This sample was not, and was not intended to be, a statistically valid sample. The Health Center’s management did prepare a schedule of discounts adjusted on the basis of the patient’s ability to pay; such schedule was periodically updated and approved by the Health Center’s board of directors and the schedule was uploaded into the Health Center’s billing system. For 3 of the 23 accounts selected for testing, the account had an incorrect discount applied due to no completed application on file. Identification as a repeat finding, if applicable: Repeat Findings, See prior year finding 2024-002. Recommendation: We recommend management work with the billing team and staff to provide additional trainings for those billers applying the slide to patient accounts and conduct additional internal reviews to verify the patient accounts have been adjusted properly and supporting applications are retained. Views of responsible officials and planned corrective actions: The Health Center will review all applicable policies and ensure that all personnel responsible for and involved in the sliding fee discount program adequately demonstrate their understanding of the sliding fee discount application program. Management will conduct internal reviews periodically throughout the year to verify patient accounts have been adjusted properly and proper supporting applications are retained.

Information on the federal program – Assistance Listing Number 93.224/93.527, Health Center Program Cluster from the U.S. Department of Health and Human Services, Federal Award No. H80CS28961 budget periods June 1, 2024 through May 31, 2025 and June 1, 2025 through May 31, 2026 Criteria or specific requirement – Health Centers must comply with federal reporting requirements Condition – The Health Center did not have adequate support for line items on its Uniform Data System (UDS) Report Cause – The turnover in management contributed to the supporting documentation not being accurately maintained for support of the respective line items. Effect or Potential Effect – The UDS Report was submitted with potential incorrect data for table 5 line 8 Total Physicians (b) Clinic Visits and (b2) Virtual Visits and line 10a Total NPs, PAs, and CNMs (b) Clinic Visits and (b2) Virtual Visits Questioned Costs – Not applicable Context – Out of a population of 1 special report, the UDS report, was tested. The tables 4, 5, 8A, and 9E from the UDS report are complete with Health Center statistics. However, the support for Table 5 statistics was unable to be obtained. Identification as a repeat finding, if applicable – Not a repeat finding Recommendation – We recommend management maintain the supporting documentation for their completed reports. Views of responsible officials and planned corrective actions – Management will review their process and policy for retaining supporting documentation.