Finding 1205046 (2025-002)

Finding 2025-002 Material Weakness in Internal Control Over Special Tests and Provisions Compliance Requirements Assistance Listing Numbers 93.224 Health Center Program 93.527 Affordable Care Act (ACA) for New and Expanded Services Under the Health Center Program Federal Agency U.S. Department of Health and Human Services, Health Resources and Services Administration Passthrough Agency N/A Award Number/Year 2025 Criteria FFHC is responsible for keeping adequate supporting documentation of the calculation of patient service fees for those patients who qualify for discounted fees based on family size and household income. FFHC is also required to apply discounted fees accurately based on an approved sliding fee scale that meets federal compliance requirements. Condition For AL No. 93.224, Health Center Program and AL 93.527, Affordable Care Act (ACA) for New and Expanded Services Under the Health Center Program, we noted nine (9) of forty (40) patient accounts selected for testing for which there was an exception when testing compliance with sliding fee discount compliance requirement. We noted the following exceptions: • We were not able to obtain supporting documentation of the household size and/or household income for two (2) of forty (40) patient accounts. • We noted three (3) of forty (40) patient accounts for which the sliding fee discount charged appeared to be incorrectly calculated based on the documented household size and income. • We noted four (4) of forty (40) patient accounts for which the amount paid by the patient didn’t match the calculated discounted fee. Cause The instances of noncompliance noted occurred due to human error as staff members were learning new procedures designed as corrective actions for this finding as identified in the audit during the previous year. Effect FFHC was not in compliance with the Special Tests and Provisions requirements applicable to the Health Center Program and Affordable Care Act (ACA) for New and Expanded Services Under the Health Center Program as prescribed by Uniform Guidance. Questioned Costs None reported. Repeat Finding Yes. See Findings 2024-003, 2023-003 and 2022-002. Recommendation We recommend that FFHC continue to implement its corrective action plan and also continue to enforce its current policy and related internal control procedures to ensure compliance with the requirement to provide discounted fees based on federally determined poverty levels for fiscal year 2025. Views of Responsible Officials and Planned Corrective Actions See corrective action plan.