Audit 54012

FY End
2022-06-30
Total Expended
$2.48M
Findings
12
Programs
8
Year: 2022 Accepted: 2022-12-12
Auditor: Terry Horne CPA

Organization Exclusion Status:

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Contacts

Name Title Type
Y3DJYKS5KDF5 Shantelle Simpson Auditee
8283543402 Terry Horne Auditor
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Notes to SEFA

Accounting Policies: Note A- Basis of PresentationThe accompanying schedule of expenditures of federal awards includes the federal award (the Schedule) of Appalachian Mountain Community Health Centers under programs of the federal government for the year ended June 30, 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 Appalachian Mountain Community Health Centers, it is not intended to and does not present the financial position, changes in net assets, or cash flows of Appalachian Mountain Community Health Centers.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. Appalachian Mountain Community Health Centers 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: 2022-001 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 eligible patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization did not properly apply the sliding fee discounts for 8 patients out of a sample of 30 patients during the year ended June 30, 2022. Cause: There were deficiencies in internal controls to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization?s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to patients. Effect: Discounts were not properly applied to patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 30 patients selected for testing, the account had an incorrect discount applied. 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 the electronic health record software be updated to correctly apply sliding fee discounts as intended based on the federal poverty guidelines. It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Shantelle Simpson, CEO Anticipated Date of Completion: January 31, 2023
Finding: 2022-002 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 verify that certain employees were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not properly document that certain vendors were not excluded from participating in federal programs. Cause: The Organization did not have proper procedures in place to ensure debarment searches were obtained or documented as required. Effect: The Organization either did not verify or did not document that certain employees and vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed and documented as required. Views of Responsible Officials: Management concurs. While the Organization did perform debarment searches on vendors during the year, documentation of the searches was not available. Management will ensure that records are retained to support these searches and will verify that employees are not suspended, debarred or otherwise excluded from participating in federal programs. Contact Person: Shantelle Simpson, CEO
Finding: 2022-001 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 eligible patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization did not properly apply the sliding fee discounts for 8 patients out of a sample of 30 patients during the year ended June 30, 2022. Cause: There were deficiencies in internal controls to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization?s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to patients. Effect: Discounts were not properly applied to patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 30 patients selected for testing, the account had an incorrect discount applied. 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 the electronic health record software be updated to correctly apply sliding fee discounts as intended based on the federal poverty guidelines. It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Shantelle Simpson, CEO Anticipated Date of Completion: January 31, 2023
Finding: 2022-002 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 verify that certain employees were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not properly document that certain vendors were not excluded from participating in federal programs. Cause: The Organization did not have proper procedures in place to ensure debarment searches were obtained or documented as required. Effect: The Organization either did not verify or did not document that certain employees and vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed and documented as required. Views of Responsible Officials: Management concurs. While the Organization did perform debarment searches on vendors during the year, documentation of the searches was not available. Management will ensure that records are retained to support these searches and will verify that employees are not suspended, debarred or otherwise excluded from participating in federal programs. Contact Person: Shantelle Simpson, CEO
Finding: 2022-001 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 eligible patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization did not properly apply the sliding fee discounts for 8 patients out of a sample of 30 patients during the year ended June 30, 2022. Cause: There were deficiencies in internal controls to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization?s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to patients. Effect: Discounts were not properly applied to patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 30 patients selected for testing, the account had an incorrect discount applied. 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 the electronic health record software be updated to correctly apply sliding fee discounts as intended based on the federal poverty guidelines. It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Shantelle Simpson, CEO Anticipated Date of Completion: January 31, 2023
Finding: 2022-002 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 verify that certain employees were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not properly document that certain vendors were not excluded from participating in federal programs. Cause: The Organization did not have proper procedures in place to ensure debarment searches were obtained or documented as required. Effect: The Organization either did not verify or did not document that certain employees and vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed and documented as required. Views of Responsible Officials: Management concurs. While the Organization did perform debarment searches on vendors during the year, documentation of the searches was not available. Management will ensure that records are retained to support these searches and will verify that employees are not suspended, debarred or otherwise excluded from participating in federal programs. Contact Person: Shantelle Simpson, CEO
Finding: 2022-001 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 eligible patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization did not properly apply the sliding fee discounts for 8 patients out of a sample of 30 patients during the year ended June 30, 2022. Cause: There were deficiencies in internal controls to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization?s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to patients. Effect: Discounts were not properly applied to patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 30 patients selected for testing, the account had an incorrect discount applied. 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 the electronic health record software be updated to correctly apply sliding fee discounts as intended based on the federal poverty guidelines. It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Shantelle Simpson, CEO Anticipated Date of Completion: January 31, 2023
Finding: 2022-002 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 verify that certain employees were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not properly document that certain vendors were not excluded from participating in federal programs. Cause: The Organization did not have proper procedures in place to ensure debarment searches were obtained or documented as required. Effect: The Organization either did not verify or did not document that certain employees and vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed and documented as required. Views of Responsible Officials: Management concurs. While the Organization did perform debarment searches on vendors during the year, documentation of the searches was not available. Management will ensure that records are retained to support these searches and will verify that employees are not suspended, debarred or otherwise excluded from participating in federal programs. Contact Person: Shantelle Simpson, CEO
Finding: 2022-001 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 eligible patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization did not properly apply the sliding fee discounts for 8 patients out of a sample of 30 patients during the year ended June 30, 2022. Cause: There were deficiencies in internal controls to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization?s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to patients. Effect: Discounts were not properly applied to patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 30 patients selected for testing, the account had an incorrect discount applied. 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 the electronic health record software be updated to correctly apply sliding fee discounts as intended based on the federal poverty guidelines. It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Shantelle Simpson, CEO Anticipated Date of Completion: January 31, 2023
Finding: 2022-002 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 verify that certain employees were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not properly document that certain vendors were not excluded from participating in federal programs. Cause: The Organization did not have proper procedures in place to ensure debarment searches were obtained or documented as required. Effect: The Organization either did not verify or did not document that certain employees and vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed and documented as required. Views of Responsible Officials: Management concurs. While the Organization did perform debarment searches on vendors during the year, documentation of the searches was not available. Management will ensure that records are retained to support these searches and will verify that employees are not suspended, debarred or otherwise excluded from participating in federal programs. Contact Person: Shantelle Simpson, CEO
Finding: 2022-001 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 eligible patients are discounted based on the patient?s ability to pay. During compliance testing, it was determined that the Organization did not properly apply the sliding fee discounts for 8 patients out of a sample of 30 patients during the year ended June 30, 2022. Cause: There were deficiencies in internal controls to ensure that proper sliding fee discounts were applied to patient accounts in accordance with the Organization?s sliding fee scale. The sliding fee scale file was not properly utilized in the application of discounts provided to patients. Effect: Discounts were not properly applied to patient accounts. Questioned Costs: None reported Context/Sampling: For 8 of 30 patients selected for testing, the account had an incorrect discount applied. 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 the electronic health record software be updated to correctly apply sliding fee discounts as intended based on the federal poverty guidelines. It is recommended that staff be trained to review sliding fee discounts applied to ensure they are accurate. Views of Responsible Officials: Management concurs. Efforts will be made to implement corrective actions as recommended above. Contact Person: Shantelle Simpson, CEO Anticipated Date of Completion: January 31, 2023
Finding: 2022-002 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 verify that certain employees were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. In addition, the Organization did not properly document that certain vendors were not excluded from participating in federal programs. Cause: The Organization did not have proper procedures in place to ensure debarment searches were obtained or documented as required. Effect: The Organization either did not verify or did not document that certain employees and vendors were not suspended, debarred, or otherwise excluded from participating in federal programs before entering into transactions with them. Questioned Costs: None reported Context/Sampling: The finding appears to be a systemic issue. Repeat Finding from Prior Year: Yes Recommendation: It is recommended that the Organization establish procedures to ensure that the procurement policy is followed and that debarment searches are performed and documented as required. Views of Responsible Officials: Management concurs. While the Organization did perform debarment searches on vendors during the year, documentation of the searches was not available. Management will ensure that records are retained to support these searches and will verify that employees are not suspended, debarred or otherwise excluded from participating in federal programs. Contact Person: Shantelle Simpson, CEO