Finding Text
2024-004 Material Weakness in Internal Control Over Special Tests – Health Center Program (93.224) Criteria: The District’s internal control structure should ensure that patients whom have filled out a sliding scale fee application were charged the appropriate rate. Condition: During the audit, it was identified three out of sixty tested patients were determined to be a full discount eligibility, self-pay patients but the associated support documents could not be located. This testing focused on the Special Tests and Provisions regarding how the District maintains program documentation for federal compliance; the missing records represent a control deficiency in record retention rather than a direct impact on expenditures. Cause: The District lacks a formal review of maintaining all of the associated documentation. This deficiency was compounded by the significant turnover in key accounting and finance personnel identified in the prior year, which prevented the District to properly review the processes. Effect: Any incorrect calculated self pay patients discount could be not properly identified. Recommendation: We recommend that the District develop and implement a formal review process. Management’s Response: Management acknowledges the finding and is committed to strengthening its review process. Questioned Costs: None. While the documentation was missing, there was no evidence that the services provided were unallowable or that the lack of documentation resulted in an overpayment of federal funds. Recurring Finding: Yes. (A similar deficiency regarding sliding scale fee overrides was identified in the prior year as Finding 2023-002).