Audit 412948

Sliding Fee Discount Documentation and Application of Policies - Significant Deficiency 2025-002 Federal Program Identification: U.S. Department of Health and Human Services Health Centers Cluster - Health Center Program, AL 93.224, Grant number H8024172 Condition/Criteria: Community Health Centers are required to offer sliding fee discounts to patients with annual incomes at or below 200% of the federal poverty guidelines. While the Organization has established policies to administer these discounts, our review identified limited instances in which supporting documentation for sliding fee discount determinations was not maintained in the patient file or the discount was not applied in accordance with the Organization’s policy. These instances indicate an opportunity to strengthen documentation practices and reinforce consistent application of the established policy. Cause: The Organization experienced constraints resulting from turnover and various other circumstances during the year. Effect: Without proper documentation and consistent application, there is a risk that patients may receive incorrect sliding fee discounts, potentially resulting in overpayment or underpayment for services. Recommendation: We recommend the Organization enhance its procedures to ensure that all required documentation used in the determination of sliding fee discounts is consistently collected and retained in each patient's file. We also recommend the Organization consistently apply the policies used to determine sliding fee discounts. View of Responsible Officials and Planned Corrective Action: See corrective action plan.

Uniform Data System Reporting - Significant Deficiency 2025-003 Federal Program Identification: U.S. Department of Health and Human Services Health Centers Cluster - Health Center Program, AL 93.224, Grant number H8024172 Condition/Criteria: The 2025 Uniform Data System (UDS) Manual requires Health Center Program grant funding reported on Table 9E to be reported based on amounts drawn down during the calendar year, consistent with Federal Financial Reports, rather than accrual-based revenue recognized under generally accepted accounting principles. During our review of the Organization's 2025 UDS submission, we noted that amounts reported on Table 9E for Health Center Program grant funding were based on accrual accounting records rather than actual drawdown activity. Cause: The Organization relied on accrual-based accounting records when preparing Table 9E and did not perform a reconciliation of reported grant amounts to federal grant drawdown activity as required by the UDS Manual. Effect: As a result, the amount reported for the Health Center Program grant on Table 9E was not reported in accordance with current UDS instructions. Recommendation: We recommend the Organization strengthen its external reporting review procedures to ensure amounts reported are prepared in accordance with reporting requirements. View of Responsible Officials and Planned Corrective Action: See corrective action plan.