Audit 414533

Criteria: Federal program requirements require health centers administering a Sliding Fee Discount Program to maintain adequate documentation supporting patient eligibility determinations and the application of discounts. Eligibility determinations should be supported by appropriate and verifiable documentation and retained in accordance with established recordkeeping requirements. Furthermore, 2 CFR §200.303 requires recipients of federal awards to establish and maintain effective internal controls that provide reasonable assurance of compliance with federal statutes, regulations, and the terms and conditions of federal awards. Cause: Established controls did not adequately ensure that required supporting documentation was obtained and retained prior to the approval of Sliding Fee Discount Program applications. In addition, monitoring procedures were not sufficient to identify instances in which eligibility documentation was incomplete or missing. Effect: The Organization was not in compliance with federal regulations. Recommendation: The Organization should strengthen internal controls over the administration of the Sliding Fee Discount Program to ensure that all applications are supported by complete and verifiable eligibility documentation prior to approval. Procedures should also be implemented to ensure supporting documentation is consistently retained and periodically reviewed to verify compliance with program requirements and organizational policies. View of Responsible Officials: Management agrees with the finding and has prepared a corrective action plan.

Criteria: Uniform Guidance requires that the reporting packet be uploaded to the Federal Audit Clearinghouse within 30 days of the issuance of the annual audit or 9 months after year end. Condition: The 2024 audit submission was not submitted by September 30, 2025. Cause: Turnover in the finance department contributed to the organization not being ready for annual audit and the audit engagement being delayed. Effect: The Organization was not in compliance with Uniform Guidance reporting requirements. Recommendation: Appropriate time and effort should be allocated to ensure the organization is ready for annual audits to meet reporting requirements of Uniform Guidance. View of Responsible Officials: Management agrees with the finding and has prepared a corrective action plan. A new CFO was hired during 2025 and has been implementing procedures to improve the timeliness of annual reporting.