Finding 1206036 (2025-002)

Material Weakness Repeat Finding
Requirement
L
Questioned Costs
-
Year
2025
Accepted
2026-04-07
Audit: 397880
Organization: Tyler Family Circle of Care (TX)

AI Summary

  • Core Issue: There was a discrepancy between the supporting documents and the final UDS report for key line items.
  • Impacted Requirements: Financial records must be retained for three years as per 2 CFR 200.334, but documentation was not kept for adjusted amounts.
  • Recommended Follow-Up: Improve processes for UDS report preparation and ensure all supporting documentation is maintained.

Finding Text

Program Name/ALN Title: Health Center Cluster Federal Assistance Listing Number: 93.224/93.527 Federal Agency: U.S. Department of Health and Human Services Award Period: 6/1/2024 – 5/31/2025, 6/1/25-5/31/26 Criteria: 2 CFR 200.334 indicates that financial records, supporting documents, statistical records, and all other non-Federal entity records pertinent to a Federal award must be retained for a period of three years from the date of submission of the final expenditure report or, for Federal awards that are renewed quarterly or annually, from the date of the submission of the quarterly or annual financial report, respectively, as reported to the Federal awarding agency. Condition: A variance was identified between the supporting documentation provided for the key line item in Table 8A, Line 17, Column C and what was reported in the final UDS report. Additionally, documentation was not available to support the amounts reported on Lines 8, Columns b and b2 and Line 10a, Columns b and b2 within Table 5. Context: Three (3) of seven (7) key line items tested. These key line items are reported in Tables 5 and 8A. Cause: Subsequent to the organization submitting its UDS report, it was requested to make a change by the initial UDS reviewer. The organization made the requested change but did not maintain documentation to support the adjusted amounts. For Table 5 the organization initially created a pivot table based on the underlying data but did not retaining this documentation and therefore couldn’t support the amounts reported. Effect: Potential for inaccurate UDS report to be filed. Recommendation: We recommend the organization enhances its current process related to the preparation of the UDS report and reinforce the requirement to maintain documentation to support the amounts reported within the various tables of the UDS report. Views of the Responsible Officials: There is no disagreement with the audit finding.

Corrective Action Plan

Health Center Program – Assistance Listing No. 93.224 Recommendation: We recommend the organization enhances its current process related to the preparation of the UDS report and reinforce the requirement to maintain documentation to support the amounts reported within the various tables within the UDS report. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: We will continue to maintain supporting documentation for our UDS submissions, to include any emails between the reviewer and FCC staff members in regards to questioned amounts and recommended reclassifications. Dental records, which are produced from a separate EMR system and require manual compilation, will be included with our UDS supporting records. Name(s) of the contact person(s) responsible for corrective action: Jennifer A. Breedlove Planned completion date for corrective action plan: March 31, 2026

Categories

Matching / Level of Effort / Earmarking

Other Findings in this Audit

  • 1206035 2025-001
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.217 FAMILY PLANNING SERVICES $291,638
93.224 HEALTH CENTER PROGRAM $201,638
93.898 CANCER PREVENTION AND CONTROL PROGRAMS FOR STATE, TERRITORIAL AND TRIBAL ORGANIZATIONS $169,424
93.527 GRANTS FOR NEW AND EXPANDED SERVICES UNDER THE HEALTH CENTER PROGRAM $18,035
93.994 MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT TO THE STATES $13,279