Finding 1165801 (2025-001)

Material Weakness Repeat Finding
Requirement
E
Questioned Costs
-
Year
2025
Accepted
2025-12-19
Audit: 376624
Auditor: RSM US LLP

AI Summary

  • Core Issue: Two patients were placed in the wrong sliding fee category despite submitting proper forms.
  • Impacted Requirements: The Organization must maintain accurate records to ensure patient eligibility for sliding fee discounts.
  • Recommended Follow-Up: Review and strengthen internal controls for verifying and retaining eligibility documentation to prevent future issues.

Finding Text

Criteria: Under this selected program, eligible individuals receive a sliding fee discount on amounts owed for health center services based on family size and income levels in comparison to the federal poverty guidelines. The Organization should maintain records providing evidence that the patients included under this program are eligible. Condition: During the compliance testing of 43 sample items, there were two instances where the patients had properly submitted their forms, but the Organization applied the incorrect sliding fee category. Effect: Currently, there is no known monetary impact, improper expenditure of funds or questioned costs identified. However, if the Organization does not strengthen the internal controls in regard to the eligibility determination process, there is a possible effect on the ability of the Organization to obtain additional funding under this program if ineligible patients are being treated with grant funding. Cause: There is a lack of review in regard to obtaining, retaining and approving documentation that support individual's eligibility for the program. Recommendation: We recommend that the Organization review policies, procedures and practices in place over the controls related to obtaining, retaining and reviewing proof of income support for patients. Repeat Finding: Yes, this is a repeat finding of 2024-001. Views of responsible officials and planned corrective actions: See attached letter. Reportable questioned costs: None

Corrective Action Plan

Identifying Number: 2025-001 - Eligibility Finding: Under the Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) and Grants for New and Expanded Services Under the Health Center Program, eligible individuals receive a sliding fee discount on amounts owed for health center services based on family size and income levels in comparison to the federal poverty guidelines. The Organization should maintain records providing evidence that the patients included under this program are eligible. However, during the compliance testing of 43 sample items, there were two instances where the patients had properly submitted their forms, but the Organization applied the incorrect sliding fee category. There is no known monetary impact, improper expenditure of funds or questioned costs identified. However, if the Organization does not strengthen the internal controls in regard to the eligibility determination process, there is a possible effect on the ability of the Organization to obtain additional funding under this program if ineligible patients are being treated with grant funding. Corrective Action Plan: The Operations and Social Work leadership met to determine a corrective action plan to address the audit findings for sliding fee scale eligibility. The leadership, under the direction of Alice Sliwka, Chief Operating and Quality Officer, will re-educate all appropriate staff who complete all eligibility ensuring standardization of naming convention for all documents received. The leadership will also review and edit the policy as the frequency of review has changed from every six months to annually. Monthly audits will continue to be completed to address any individual issue of non-compliance. Monthly follow-up and review of all findings will be shared with the Quality Excellence Committee until full compliance is maintained. Chase Brexton anticipates completion of this by March 31, 2026.

Categories

Eligibility Internal Control / Segregation of Duties

Other Findings in this Audit

  • 1165798 2025-001
    Material Weakness Repeat
  • 1165799 2025-001
    Material Weakness Repeat
  • 1165800 2025-001
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.914 HIV EMERGENCY RELIEF PROJECT GRANTS $1.14M
93.918 GRANTS TO PROVIDE OUTPATIENT EARLY INTERVENTION SERVICES WITH RESPECT TO HIV DISEASE $1.05M
93.917 HIV CARE FORMULA GRANTS $327,325
93.977 SEXUALLY TRANSMITTED DISEASES (STD) PREVENTION AND CONTROL GRANTS $311,846
93.527 AFFORDABLE CARE ACT (ACA) GRANTS FOR NEW AND EXPANDED SERVICES UNDER THE HEALTH CENTER PROGRAM $183,000
93.686 ENDING THE HIV EPIDEMIC: A PLAN FOR AMERICA � RYAN WHITE HIV/AIDS PROGRAM PARTS A AND B $150,630
93.224 COMMUNITY HEALTH CENTERS $122,000
93.247 ADVANCED EDUCATION NURSING GRANT PROGRAM $100,000
93.940 HIV PREVENTION ACTIVITIES HEALTH DEPARTMENT BASED $95,658
93.526 FIP VERIFICATION $32,094