Finding 1205000 (2024-010)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2026-03-30
Audit: 396662
Organization: The City of Frederick, Maryland (MD)
Auditor: SB & COMPANY LLC

AI Summary

  • Core Issue: The City failed to provide necessary documentation for 25 patients regarding the sliding fee discount schedule, indicating a lack of compliance with federal regulations.
  • Impacted Requirements: Compliance with 42 USC and 42 CFR regulations requiring health centers to adjust fees based on patients' ability to pay.
  • Recommended Follow-Up: Ensure proper management oversight, train employees on Allscripts software, and create a user manual for consistent patient record documentation.

Finding Text

Finding 2024-010 U.S. Department of Health and Human Services Assistance Listing Number 93.224, 93.527 – Health Center Program Cluster Material Weakness and Noncompliance over Special Tests and Provisions Repeat Finding: Yes, 2023-005 Criteria: According to 42 USC 254b(k)(3)(E), (F), and (G); 42 CFR sections 51c.303(e), (f), and (g), and 42 CFR sections 56.303(e), (f), and (g)), health centers must prepare and apply a sliding fee discount schedule (SFDS) so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. Condition and Context: The City did not provide the support showing compliance for 25 out of 25 patients selected. Cause: There is no management oversight in this area. Also, employees have not been properly trained and are not consistently utilizing the Allscripts software that maintains patient data. Effect or Potential Effect: The City is not compliant with federal regulations which could result in the federal government imposing additional requirements or withholding, disallowing or suspending grant funds. Questioned Costs: Unknown. Recommendation: All elements required for the sliding fee discount should be properly maintained in Allscripts. Employees should be properly trained on the software, and a user manual should be created related to patient intake so patient records are consistent and documented appropriately. Views of Responsible Officials: Management agrees with the finding. Refer to the Corrective Action Plan Section of this report.

Corrective Action Plan

Finding reference: 2024-010 - 93.224, 93.527 – Health Center Program Cluster Material Weakness and Noncompliance over Special Tests and Provisions Recommendation: All elements required for the sliding fee discount should be properly maintained in Allscripts. Employees should be properly trained on the software, and a user manual should be created related to patient intake so patient records are consistent and documented appropriately. Action taken: All elements required for the sliding fee discount are being properly maintained. All employees have been properly trained in software.

Categories

Special Tests & Provisions Material Weakness Internal Control / Segregation of Duties

Other Findings in this Audit

  • 1204983 2024-003
    Material Weakness Repeat
  • 1204984 2024-003
    Material Weakness Repeat
  • 1204985 2024-003
    Material Weakness Repeat
  • 1204986 2024-003
    Material Weakness Repeat
  • 1204987 2024-003
    Material Weakness Repeat
  • 1204988 2024-003
    Material Weakness Repeat
  • 1204989 2024-008
    Material Weakness Repeat
  • 1204990 2024-009
    Material Weakness Repeat
  • 1204991 2024-010
    Material Weakness Repeat
  • 1204992 2024-008
    Material Weakness Repeat
  • 1204993 2024-009
    Material Weakness Repeat
  • 1204994 2024-010
    Material Weakness Repeat
  • 1204995 2024-008
    Material Weakness Repeat
  • 1204996 2024-009
    Material Weakness Repeat
  • 1204997 2024-010
    Material Weakness Repeat
  • 1204998 2024-008
    Material Weakness Repeat
  • 1204999 2024-009
    Material Weakness Repeat
  • 1205001 2024-004
    Material Weakness Repeat
  • 1205002 2024-005
    Material Weakness Repeat
  • 1205003 2024-006
    Material Weakness Repeat
  • 1205004 2024-007
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
21.027 CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY FUNDS $2.27M
97.036 DISASTER GRANTS - PUBLIC ASSISTANCE $1.67M
93.137 COMMUNITY PROGRAMS TO IMPROVE MINORITY HEALTH $815,135
10.558 CHILD AND ADULT CARE FOOD PROGRAM $786,906
93.224 COVID-19 - HEALTH CENTER PROGRAM $448,049
93.569 COMMUNITY SERVICES BLOCK GRANT $304,444
93.224 HEALTH CENTER PROGRAM $218,425
14.218 COVID-19 - COMMUNITY DEVELOPMENT BLOCK GRANTS/EMTITLEMENT GRANTS $167,294
10.935 URBAN AGRICULTURE AND INNOVATIVE PRODUCTION $152,301
14.218 COMMUNITY DEVELOPMENT BLOCK GRANTS/ENTITLEMENT GRANTS $151,662
81.042 WEATHERIZATION ASSISTANCE FOR LOW-INCOME PERSONS $114,445
20.106 AIRPORT IMPROVEMENT PROGRAM $107,000
16.745 CRIMINAL AND JUVENILE JUSTICE AND MENTAL HEALTH COLLABORATION PROGRAM $94,283
16.738 TRAINING AND TECHNOLOGY IMPROVEMENT PROJECT $89,837
16.738 BRYNE DISCRETIONARY COMMUNITY PROJECT FUNDING/BYRNE DISCRETIONARY GRANTS PROGRAM $83,450
93.150 PROJECTS FOR ASSISTANCE IN TRANSITION FROM HOMELESSNESS (PATH) $76,265
16.710 PUBLIC SAFETY PARTNERSHIP AND COMMUNITY POLICING GRANTS $70,125
14.231 EMERGENCY SOLUTIONS GRANT PROGRAM $62,686
16.738 EDWARD BYRNE MEMORIAL JUSTICE ASSISTANCE GRANT PROGRAM $42,538
10.559 SUMMER FOOD SERVICE PROGRAM FOR CHILDREN $35,917
93.527 GRANTS FOR NEW AND EXPANDED SERVICES UNDER THE HEALTH CENTER PROGRAM $22,020
95.001 HIGH INTENSITY DRUG TRAFFICKING AREAS PROGRAM $19,548
93.568 LOW-INCOME HOME ENERGY ASSISTANCE $18,097
97.067 STATE HOMELAND SECURITY GRANT PROGRAM $15,800
93.499 LOW INCOME HOUSEHOLD WATER ASSISTANCE PROGRAM $10,156
21.026 HOMEOWNER ASSISTANCE FUND $8,503
20.600 STATE AND COMMUNITY HIGHWAY SAFETY $8,086
20.616 NATIONAL PRIORITY SAFETY PROGRAMS $7,677
14.267 CONTINUUM OF CARE PROGRAM $6,610
84.425 EDUCATION STABILIZATION FUND $5,010