Audit 43936

FY End
2022-03-31
Total Expended
$8.71M
Findings
30
Programs
9
Year: 2022 Accepted: 2022-12-12
Auditor: Terry Horne CPA

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
45399 2022-003 Material Weakness Yes N
45400 2022-004 Material Weakness Yes L
45401 2022-005 Material Weakness - I
45402 2022-003 Material Weakness Yes N
45403 2022-004 Material Weakness Yes L
45404 2022-005 Material Weakness - I
45405 2022-003 Material Weakness Yes N
45406 2022-004 Material Weakness Yes L
45407 2022-005 Material Weakness - I
45408 2022-003 Material Weakness Yes N
45409 2022-004 Material Weakness Yes L
45410 2022-005 Material Weakness - I
45411 2022-003 Material Weakness Yes N
45412 2022-004 Material Weakness Yes L
45413 2022-005 Material Weakness - I
621841 2022-003 Material Weakness Yes N
621842 2022-004 Material Weakness Yes L
621843 2022-005 Material Weakness - I
621844 2022-003 Material Weakness Yes N
621845 2022-004 Material Weakness Yes L
621846 2022-005 Material Weakness - I
621847 2022-003 Material Weakness Yes N
621848 2022-004 Material Weakness Yes L
621849 2022-005 Material Weakness - I
621850 2022-003 Material Weakness Yes N
621851 2022-004 Material Weakness Yes L
621852 2022-005 Material Weakness - I
621853 2022-003 Material Weakness Yes N
621854 2022-004 Material Weakness Yes L
621855 2022-005 Material Weakness - I

Contacts

Name Title Type
C1E1FPLEVFL8 Michael Savino Auditee
8437224122 Terry Horne Auditor
No contacts on file

Notes to SEFA

Accounting Policies: Note A- Basis of PresentationThe accompanying schedule of expenditures of federal awards includes the federal award (the Schedule) of Fetter Health Care Network, Inc. under programs of the federal government for the year ended March 31, 2022. The information in this Schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the Schedule presents only a selected portion of the operations of Fetter Health Care Network, Inc. it is not intended to and does not present the financial position, changes in net assets, or cash flows of Fetter Health Care Network, Inc.Note B-Summary of Significant Accounting PoliciesExpenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. Negative amounts shown on the Schedule represent adjustments or credits made in the normal course of business to amounts reported as expenditures in prior years. Fetter Health Care Network, Inc. has elected not to use the 10 percent de minimus indirect cost rate allowed under Uniform Guidance.Note C- SubrecipientsThe Organization provided no federal awards to subrecipients. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate.

Finding Details

Finding: 2022-003 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization either did not properly apply the sliding fee discount or did not properly document the sliding fee discount applied for eight sliding fee patients tested. Cause: There were deficiencies in the internal controls that ensure proper documentation is obtained and that proper sliding fee discounts are applied to patient accounts in accordance with the Organization?s sliding fee policy and sliding fee scale. Effect: Discounts were not properly applied to certain patient accounts and proper documentation was not obtained to support the sliding fee discount applied to certain patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 40 sliding fee patients selected for testing, the account either had an incorrect discount applied, or the documentation to support the discount applied was incomplete. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that proper training be given to employees and that the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-004 Reporting Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Organizations that receive federal awards in excess of $750,000 are required to submit an annual Federal Data Collection Form, including audited financial statements, no later than nine months after the fiscal year end to the Federal Audit Clearinghouse. Condition: The Federal Data Collection Form and audit report for the year ended March 31, 2021 were not submitted until July 20, 2022, which was beyond the extended filing period of June 30, 2022. Cause: The Organization encountered significant delays in providing information necessary to prepare the 2021 audit. Effect: The Organization is not in compliance with federal filing requirements, which could impact availability of federal funds. Questioned Costs: None reported Context/Sampling: None Repeat Finding from Prior Year: Yes Recommendation: It is recommended that management develop a timeline that allows for preparation of necessary information needed to complete the annual audit and Federal Data Collection Form in a timely manner. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-005 Procurement, Suspension, and Debarment Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Procurement 45 CFR 75.329 and 45 CFR 75.213 Condition: The Organization did not properly document verification that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Cause: The Organization did not have proper policies and procedures in place to ensure and document that debarment searches and bids, purchase orders, and receiving reports were obtained as required. Effect: The Organization did not verify that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed as required. Views of Responsible Officials: Management concurs. The Organization will establish procedures to ensure that debarment searches are completed to verify that all vendors subject to debarment requirements are not suspended, debarred, or otherwise excluded from participating in Federal programs before the Organization enters into transactions with them. The Organization will also establish procedures to ensure that bids, purchase orders, and receiving reports are obtained in accordance with the Organization?s procurement policy. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-003 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization either did not properly apply the sliding fee discount or did not properly document the sliding fee discount applied for eight sliding fee patients tested. Cause: There were deficiencies in the internal controls that ensure proper documentation is obtained and that proper sliding fee discounts are applied to patient accounts in accordance with the Organization?s sliding fee policy and sliding fee scale. Effect: Discounts were not properly applied to certain patient accounts and proper documentation was not obtained to support the sliding fee discount applied to certain patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 40 sliding fee patients selected for testing, the account either had an incorrect discount applied, or the documentation to support the discount applied was incomplete. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that proper training be given to employees and that the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-004 Reporting Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Organizations that receive federal awards in excess of $750,000 are required to submit an annual Federal Data Collection Form, including audited financial statements, no later than nine months after the fiscal year end to the Federal Audit Clearinghouse. Condition: The Federal Data Collection Form and audit report for the year ended March 31, 2021 were not submitted until July 20, 2022, which was beyond the extended filing period of June 30, 2022. Cause: The Organization encountered significant delays in providing information necessary to prepare the 2021 audit. Effect: The Organization is not in compliance with federal filing requirements, which could impact availability of federal funds. Questioned Costs: None reported Context/Sampling: None Repeat Finding from Prior Year: Yes Recommendation: It is recommended that management develop a timeline that allows for preparation of necessary information needed to complete the annual audit and Federal Data Collection Form in a timely manner. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-005 Procurement, Suspension, and Debarment Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Procurement 45 CFR 75.329 and 45 CFR 75.213 Condition: The Organization did not properly document verification that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Cause: The Organization did not have proper policies and procedures in place to ensure and document that debarment searches and bids, purchase orders, and receiving reports were obtained as required. Effect: The Organization did not verify that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed as required. Views of Responsible Officials: Management concurs. The Organization will establish procedures to ensure that debarment searches are completed to verify that all vendors subject to debarment requirements are not suspended, debarred, or otherwise excluded from participating in Federal programs before the Organization enters into transactions with them. The Organization will also establish procedures to ensure that bids, purchase orders, and receiving reports are obtained in accordance with the Organization?s procurement policy. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-003 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization either did not properly apply the sliding fee discount or did not properly document the sliding fee discount applied for eight sliding fee patients tested. Cause: There were deficiencies in the internal controls that ensure proper documentation is obtained and that proper sliding fee discounts are applied to patient accounts in accordance with the Organization?s sliding fee policy and sliding fee scale. Effect: Discounts were not properly applied to certain patient accounts and proper documentation was not obtained to support the sliding fee discount applied to certain patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 40 sliding fee patients selected for testing, the account either had an incorrect discount applied, or the documentation to support the discount applied was incomplete. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that proper training be given to employees and that the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-004 Reporting Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Organizations that receive federal awards in excess of $750,000 are required to submit an annual Federal Data Collection Form, including audited financial statements, no later than nine months after the fiscal year end to the Federal Audit Clearinghouse. Condition: The Federal Data Collection Form and audit report for the year ended March 31, 2021 were not submitted until July 20, 2022, which was beyond the extended filing period of June 30, 2022. Cause: The Organization encountered significant delays in providing information necessary to prepare the 2021 audit. Effect: The Organization is not in compliance with federal filing requirements, which could impact availability of federal funds. Questioned Costs: None reported Context/Sampling: None Repeat Finding from Prior Year: Yes Recommendation: It is recommended that management develop a timeline that allows for preparation of necessary information needed to complete the annual audit and Federal Data Collection Form in a timely manner. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-005 Procurement, Suspension, and Debarment Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Procurement 45 CFR 75.329 and 45 CFR 75.213 Condition: The Organization did not properly document verification that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Cause: The Organization did not have proper policies and procedures in place to ensure and document that debarment searches and bids, purchase orders, and receiving reports were obtained as required. Effect: The Organization did not verify that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed as required. Views of Responsible Officials: Management concurs. The Organization will establish procedures to ensure that debarment searches are completed to verify that all vendors subject to debarment requirements are not suspended, debarred, or otherwise excluded from participating in Federal programs before the Organization enters into transactions with them. The Organization will also establish procedures to ensure that bids, purchase orders, and receiving reports are obtained in accordance with the Organization?s procurement policy. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-003 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization either did not properly apply the sliding fee discount or did not properly document the sliding fee discount applied for eight sliding fee patients tested. Cause: There were deficiencies in the internal controls that ensure proper documentation is obtained and that proper sliding fee discounts are applied to patient accounts in accordance with the Organization?s sliding fee policy and sliding fee scale. Effect: Discounts were not properly applied to certain patient accounts and proper documentation was not obtained to support the sliding fee discount applied to certain patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 40 sliding fee patients selected for testing, the account either had an incorrect discount applied, or the documentation to support the discount applied was incomplete. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that proper training be given to employees and that the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-004 Reporting Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Organizations that receive federal awards in excess of $750,000 are required to submit an annual Federal Data Collection Form, including audited financial statements, no later than nine months after the fiscal year end to the Federal Audit Clearinghouse. Condition: The Federal Data Collection Form and audit report for the year ended March 31, 2021 were not submitted until July 20, 2022, which was beyond the extended filing period of June 30, 2022. Cause: The Organization encountered significant delays in providing information necessary to prepare the 2021 audit. Effect: The Organization is not in compliance with federal filing requirements, which could impact availability of federal funds. Questioned Costs: None reported Context/Sampling: None Repeat Finding from Prior Year: Yes Recommendation: It is recommended that management develop a timeline that allows for preparation of necessary information needed to complete the annual audit and Federal Data Collection Form in a timely manner. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-005 Procurement, Suspension, and Debarment Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Procurement 45 CFR 75.329 and 45 CFR 75.213 Condition: The Organization did not properly document verification that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Cause: The Organization did not have proper policies and procedures in place to ensure and document that debarment searches and bids, purchase orders, and receiving reports were obtained as required. Effect: The Organization did not verify that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed as required. Views of Responsible Officials: Management concurs. The Organization will establish procedures to ensure that debarment searches are completed to verify that all vendors subject to debarment requirements are not suspended, debarred, or otherwise excluded from participating in Federal programs before the Organization enters into transactions with them. The Organization will also establish procedures to ensure that bids, purchase orders, and receiving reports are obtained in accordance with the Organization?s procurement policy. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-003 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization either did not properly apply the sliding fee discount or did not properly document the sliding fee discount applied for eight sliding fee patients tested. Cause: There were deficiencies in the internal controls that ensure proper documentation is obtained and that proper sliding fee discounts are applied to patient accounts in accordance with the Organization?s sliding fee policy and sliding fee scale. Effect: Discounts were not properly applied to certain patient accounts and proper documentation was not obtained to support the sliding fee discount applied to certain patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 40 sliding fee patients selected for testing, the account either had an incorrect discount applied, or the documentation to support the discount applied was incomplete. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that proper training be given to employees and that the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-004 Reporting Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Organizations that receive federal awards in excess of $750,000 are required to submit an annual Federal Data Collection Form, including audited financial statements, no later than nine months after the fiscal year end to the Federal Audit Clearinghouse. Condition: The Federal Data Collection Form and audit report for the year ended March 31, 2021 were not submitted until July 20, 2022, which was beyond the extended filing period of June 30, 2022. Cause: The Organization encountered significant delays in providing information necessary to prepare the 2021 audit. Effect: The Organization is not in compliance with federal filing requirements, which could impact availability of federal funds. Questioned Costs: None reported Context/Sampling: None Repeat Finding from Prior Year: Yes Recommendation: It is recommended that management develop a timeline that allows for preparation of necessary information needed to complete the annual audit and Federal Data Collection Form in a timely manner. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-005 Procurement, Suspension, and Debarment Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Procurement 45 CFR 75.329 and 45 CFR 75.213 Condition: The Organization did not properly document verification that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Cause: The Organization did not have proper policies and procedures in place to ensure and document that debarment searches and bids, purchase orders, and receiving reports were obtained as required. Effect: The Organization did not verify that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed as required. Views of Responsible Officials: Management concurs. The Organization will establish procedures to ensure that debarment searches are completed to verify that all vendors subject to debarment requirements are not suspended, debarred, or otherwise excluded from participating in Federal programs before the Organization enters into transactions with them. The Organization will also establish procedures to ensure that bids, purchase orders, and receiving reports are obtained in accordance with the Organization?s procurement policy. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-003 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization either did not properly apply the sliding fee discount or did not properly document the sliding fee discount applied for eight sliding fee patients tested. Cause: There were deficiencies in the internal controls that ensure proper documentation is obtained and that proper sliding fee discounts are applied to patient accounts in accordance with the Organization?s sliding fee policy and sliding fee scale. Effect: Discounts were not properly applied to certain patient accounts and proper documentation was not obtained to support the sliding fee discount applied to certain patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 40 sliding fee patients selected for testing, the account either had an incorrect discount applied, or the documentation to support the discount applied was incomplete. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that proper training be given to employees and that the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-004 Reporting Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Organizations that receive federal awards in excess of $750,000 are required to submit an annual Federal Data Collection Form, including audited financial statements, no later than nine months after the fiscal year end to the Federal Audit Clearinghouse. Condition: The Federal Data Collection Form and audit report for the year ended March 31, 2021 were not submitted until July 20, 2022, which was beyond the extended filing period of June 30, 2022. Cause: The Organization encountered significant delays in providing information necessary to prepare the 2021 audit. Effect: The Organization is not in compliance with federal filing requirements, which could impact availability of federal funds. Questioned Costs: None reported Context/Sampling: None Repeat Finding from Prior Year: Yes Recommendation: It is recommended that management develop a timeline that allows for preparation of necessary information needed to complete the annual audit and Federal Data Collection Form in a timely manner. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-005 Procurement, Suspension, and Debarment Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Procurement 45 CFR 75.329 and 45 CFR 75.213 Condition: The Organization did not properly document verification that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Cause: The Organization did not have proper policies and procedures in place to ensure and document that debarment searches and bids, purchase orders, and receiving reports were obtained as required. Effect: The Organization did not verify that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed as required. Views of Responsible Officials: Management concurs. The Organization will establish procedures to ensure that debarment searches are completed to verify that all vendors subject to debarment requirements are not suspended, debarred, or otherwise excluded from participating in Federal programs before the Organization enters into transactions with them. The Organization will also establish procedures to ensure that bids, purchase orders, and receiving reports are obtained in accordance with the Organization?s procurement policy. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-003 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization either did not properly apply the sliding fee discount or did not properly document the sliding fee discount applied for eight sliding fee patients tested. Cause: There were deficiencies in the internal controls that ensure proper documentation is obtained and that proper sliding fee discounts are applied to patient accounts in accordance with the Organization?s sliding fee policy and sliding fee scale. Effect: Discounts were not properly applied to certain patient accounts and proper documentation was not obtained to support the sliding fee discount applied to certain patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 40 sliding fee patients selected for testing, the account either had an incorrect discount applied, or the documentation to support the discount applied was incomplete. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that proper training be given to employees and that the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-004 Reporting Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Organizations that receive federal awards in excess of $750,000 are required to submit an annual Federal Data Collection Form, including audited financial statements, no later than nine months after the fiscal year end to the Federal Audit Clearinghouse. Condition: The Federal Data Collection Form and audit report for the year ended March 31, 2021 were not submitted until July 20, 2022, which was beyond the extended filing period of June 30, 2022. Cause: The Organization encountered significant delays in providing information necessary to prepare the 2021 audit. Effect: The Organization is not in compliance with federal filing requirements, which could impact availability of federal funds. Questioned Costs: None reported Context/Sampling: None Repeat Finding from Prior Year: Yes Recommendation: It is recommended that management develop a timeline that allows for preparation of necessary information needed to complete the annual audit and Federal Data Collection Form in a timely manner. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-005 Procurement, Suspension, and Debarment Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Procurement 45 CFR 75.329 and 45 CFR 75.213 Condition: The Organization did not properly document verification that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Cause: The Organization did not have proper policies and procedures in place to ensure and document that debarment searches and bids, purchase orders, and receiving reports were obtained as required. Effect: The Organization did not verify that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed as required. Views of Responsible Officials: Management concurs. The Organization will establish procedures to ensure that debarment searches are completed to verify that all vendors subject to debarment requirements are not suspended, debarred, or otherwise excluded from participating in Federal programs before the Organization enters into transactions with them. The Organization will also establish procedures to ensure that bids, purchase orders, and receiving reports are obtained in accordance with the Organization?s procurement policy. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-003 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization either did not properly apply the sliding fee discount or did not properly document the sliding fee discount applied for eight sliding fee patients tested. Cause: There were deficiencies in the internal controls that ensure proper documentation is obtained and that proper sliding fee discounts are applied to patient accounts in accordance with the Organization?s sliding fee policy and sliding fee scale. Effect: Discounts were not properly applied to certain patient accounts and proper documentation was not obtained to support the sliding fee discount applied to certain patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 40 sliding fee patients selected for testing, the account either had an incorrect discount applied, or the documentation to support the discount applied was incomplete. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that proper training be given to employees and that the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-004 Reporting Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Organizations that receive federal awards in excess of $750,000 are required to submit an annual Federal Data Collection Form, including audited financial statements, no later than nine months after the fiscal year end to the Federal Audit Clearinghouse. Condition: The Federal Data Collection Form and audit report for the year ended March 31, 2021 were not submitted until July 20, 2022, which was beyond the extended filing period of June 30, 2022. Cause: The Organization encountered significant delays in providing information necessary to prepare the 2021 audit. Effect: The Organization is not in compliance with federal filing requirements, which could impact availability of federal funds. Questioned Costs: None reported Context/Sampling: None Repeat Finding from Prior Year: Yes Recommendation: It is recommended that management develop a timeline that allows for preparation of necessary information needed to complete the annual audit and Federal Data Collection Form in a timely manner. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-005 Procurement, Suspension, and Debarment Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Procurement 45 CFR 75.329 and 45 CFR 75.213 Condition: The Organization did not properly document verification that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Cause: The Organization did not have proper policies and procedures in place to ensure and document that debarment searches and bids, purchase orders, and receiving reports were obtained as required. Effect: The Organization did not verify that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed as required. Views of Responsible Officials: Management concurs. The Organization will establish procedures to ensure that debarment searches are completed to verify that all vendors subject to debarment requirements are not suspended, debarred, or otherwise excluded from participating in Federal programs before the Organization enters into transactions with them. The Organization will also establish procedures to ensure that bids, purchase orders, and receiving reports are obtained in accordance with the Organization?s procurement policy. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-003 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization either did not properly apply the sliding fee discount or did not properly document the sliding fee discount applied for eight sliding fee patients tested. Cause: There were deficiencies in the internal controls that ensure proper documentation is obtained and that proper sliding fee discounts are applied to patient accounts in accordance with the Organization?s sliding fee policy and sliding fee scale. Effect: Discounts were not properly applied to certain patient accounts and proper documentation was not obtained to support the sliding fee discount applied to certain patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 40 sliding fee patients selected for testing, the account either had an incorrect discount applied, or the documentation to support the discount applied was incomplete. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that proper training be given to employees and that the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-004 Reporting Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Organizations that receive federal awards in excess of $750,000 are required to submit an annual Federal Data Collection Form, including audited financial statements, no later than nine months after the fiscal year end to the Federal Audit Clearinghouse. Condition: The Federal Data Collection Form and audit report for the year ended March 31, 2021 were not submitted until July 20, 2022, which was beyond the extended filing period of June 30, 2022. Cause: The Organization encountered significant delays in providing information necessary to prepare the 2021 audit. Effect: The Organization is not in compliance with federal filing requirements, which could impact availability of federal funds. Questioned Costs: None reported Context/Sampling: None Repeat Finding from Prior Year: Yes Recommendation: It is recommended that management develop a timeline that allows for preparation of necessary information needed to complete the annual audit and Federal Data Collection Form in a timely manner. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-005 Procurement, Suspension, and Debarment Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Procurement 45 CFR 75.329 and 45 CFR 75.213 Condition: The Organization did not properly document verification that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Cause: The Organization did not have proper policies and procedures in place to ensure and document that debarment searches and bids, purchase orders, and receiving reports were obtained as required. Effect: The Organization did not verify that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed as required. Views of Responsible Officials: Management concurs. The Organization will establish procedures to ensure that debarment searches are completed to verify that all vendors subject to debarment requirements are not suspended, debarred, or otherwise excluded from participating in Federal programs before the Organization enters into transactions with them. The Organization will also establish procedures to ensure that bids, purchase orders, and receiving reports are obtained in accordance with the Organization?s procurement policy. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-003 Sliding Fee Discounts Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Uniform Guidance, Special Tests & Provisions, Sliding Fee Discounts, 42 CFR, 56.303 Condition: Health Centers receiving funding under the Health Center Program Cluster must prepare and apply a sliding fee discount so that the amounts owed for health center services by patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization either did not properly apply the sliding fee discount or did not properly document the sliding fee discount applied for eight sliding fee patients tested. Cause: There were deficiencies in the internal controls that ensure proper documentation is obtained and that proper sliding fee discounts are applied to patient accounts in accordance with the Organization?s sliding fee policy and sliding fee scale. Effect: Discounts were not properly applied to certain patient accounts and proper documentation was not obtained to support the sliding fee discount applied to certain patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 40 sliding fee patients selected for testing, the account either had an incorrect discount applied, or the documentation to support the discount applied was incomplete. This sample was not, and was not intended to be, a statistically valid sample. The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that proper training be given to employees and that the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-004 Reporting Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Organizations that receive federal awards in excess of $750,000 are required to submit an annual Federal Data Collection Form, including audited financial statements, no later than nine months after the fiscal year end to the Federal Audit Clearinghouse. Condition: The Federal Data Collection Form and audit report for the year ended March 31, 2021 were not submitted until July 20, 2022, which was beyond the extended filing period of June 30, 2022. Cause: The Organization encountered significant delays in providing information necessary to prepare the 2021 audit. Effect: The Organization is not in compliance with federal filing requirements, which could impact availability of federal funds. Questioned Costs: None reported Context/Sampling: None Repeat Finding from Prior Year: Yes Recommendation: It is recommended that management develop a timeline that allows for preparation of necessary information needed to complete the annual audit and Federal Data Collection Form in a timely manner. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023
Finding: 2022-005 Procurement, Suspension, and Debarment Federal Programs: Department of Health and Human Services Health Center Program Cluster CFDA 93.224 and 93.527 Criteria: Procurement 45 CFR 75.329 and 45 CFR 75.213 Condition: The Organization did not properly document verification that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Cause: The Organization did not have proper policies and procedures in place to ensure and document that debarment searches and bids, purchase orders, and receiving reports were obtained as required. Effect: The Organization did not verify that certain vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not obtain bids, purchase orders, and receiving reports for certain purchases in accordance with established policies. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: No Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed as required. Views of Responsible Officials: Management concurs. The Organization will establish procedures to ensure that debarment searches are completed to verify that all vendors subject to debarment requirements are not suspended, debarred, or otherwise excluded from participating in Federal programs before the Organization enters into transactions with them. The Organization will also establish procedures to ensure that bids, purchase orders, and receiving reports are obtained in accordance with the Organization?s procurement policy. Contact Person: Michael Savino, CFO Anticipated Date of Completion: January 31, 2023