Finding 389753 (2023-004)

Material Weakness
Requirement
N
Questioned Costs
-
Year
2023
Accepted
2024-03-29
Audit: 300633
Organization: County of Ventura (CA)
Auditor: Eide Bailly LLP

AI Summary

  • Core Issue: The County failed to apply sliding fee discounts correctly in 6 out of 93 cases, violating compliance requirements under Title 42 USC 254b(k)(3)(F).
  • Impacted Requirements: The County's internal controls over compliance are weak, leading to inconsistent application of patient charges and discounts.
  • Recommended Follow-up: Strengthen policies and procedures to ensure adherence to sliding fee discount schedules and improve training for County personnel.

Finding Text

2023-004 Program: COVID-19 Health Center Program Cluster Assistance Listing No.: 93.224 Federal Grantor: U.S. Department of Health and Human Services Passed-through: N/A Award No. and Year: Various Compliance Requirement: Special Tests and Provisions Type of Finding: Material Weakness in Internal Control over Compliance and Material Noncompliance Criteria: Per Title 42 USC 254b(k)(3)(F), the Center has made or will make and will continue to make every reasonable effort to collect appropriate reimbursement for its costs in providing health services to persons who are entitled to insurance benefits under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.], to medical assistance under a State plan approved under title XIX of such Act [42 U.S.C. 1396 et seq.], or to assistance for medical expenses under any other public assistance program or private health insurance program; (G) the center—(i) has prepared a schedule of fees or payments for the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient’s ability to pay; (ii) has made and will continue to make every reasonable effort—(I) to secure from patients payment for services in accordance with such schedules. Condition: We noted 6 instances out of 93 where the County did not appropriately adjust patient charges based on the Health Center’s sliding fee discount program schedules in accordance with 42 USC 254b(k)(3)(F). Cause: The condition is primarily caused by the County not following the policies and procedures in place to ensure the sliding fee discounts to patient charges were applied consistent with its sliding fee discount program schedules. Effect: Discounts applied to patient charges were inconsistent with its sliding fee discount program schedules. Questioned Costs: None reported. Context/Sampling: A nonstatistical sample of 93 participants out of 11,862 participants were selected for testing. The condition noted above was identified during our procedures over the County’s sliding fee discount program procedures. Repeat Finding from Prior Years: No. Recommendation: We recommend that the County strengthen its established policies and procedures to ensure the sliding fee discount program schedules are applied to patient charges consistent with its sliding fee discount schedules and ensure that policies and procedures are strictly adhered to by County personnel. Views of Responsible Officials: Management agrees. See separately issued Corrective Action Plan.

Categories

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

Other Findings in this Audit

  • 389741 2023-003
    Significant Deficiency
  • 389742 2023-003
    Significant Deficiency
  • 389743 2023-003
    Significant Deficiency
  • 389744 2023-003
    Significant Deficiency
  • 389745 2023-003
    Significant Deficiency
  • 389746 2023-003
    Significant Deficiency
  • 389747 2023-003
    Significant Deficiency
  • 389748 2023-003
    Significant Deficiency
  • 389749 2023-003
    Significant Deficiency
  • 389750 2023-003
    Significant Deficiency
  • 389751 2023-003
    Significant Deficiency
  • 389752 2023-004
    Material Weakness
  • 389754 2023-004
    Material Weakness
  • 389755 2023-004
    Material Weakness
  • 389756 2023-004
    Material Weakness
  • 389757 2023-004
    Material Weakness
  • 389758 2023-004
    Material Weakness
  • 966183 2023-003
    Significant Deficiency
  • 966184 2023-003
    Significant Deficiency
  • 966185 2023-003
    Significant Deficiency
  • 966186 2023-003
    Significant Deficiency
  • 966187 2023-003
    Significant Deficiency
  • 966188 2023-003
    Significant Deficiency
  • 966189 2023-003
    Significant Deficiency
  • 966190 2023-003
    Significant Deficiency
  • 966191 2023-003
    Significant Deficiency
  • 966192 2023-003
    Significant Deficiency
  • 966193 2023-003
    Significant Deficiency
  • 966194 2023-004
    Material Weakness
  • 966195 2023-004
    Material Weakness
  • 966196 2023-004
    Material Weakness
  • 966197 2023-004
    Material Weakness
  • 966198 2023-004
    Material Weakness
  • 966199 2023-004
    Material Weakness
  • 966200 2023-004
    Material Weakness

Programs in Audit

ALN Program Name Expenditures
21.027 Covid-19 Coronavirus State and Local Fiscal Recovery Funds $162.28M
93.563 Child Support Enforcement $14.48M
93.659 Adoption Assistance $12.42M
93.090 Guardianship Assistance $2.67M
93.045 Special Programs for the Aging_title Iii, Part C_nutrition Services $1.75M
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $1.65M
93.556 Promoting Safe and Stable Families $1.44M
16.606 State Criminal Alien Assistance Program $1.15M
97.036 Covid-19 Disaster Grants - Public Assistance (presidentially Declared Disasters) $1.10M
97.067 Homeland Security Grant Program $932,671
93.959 Block Grants for Prevention and Treatment of Substance Abuse $920,974
93.044 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $882,753
93.958 Block Grants for Community Mental Health Services $789,937
17.270 Reintegration of Ex-Offenders $731,726
93.658 Foster Care_title IV-E $720,605
93.667 Social Services Block Grant $599,398
20.205 Highway Planning and Construction $572,424
14.218 Covid-19 Community Development Block Grants/entitlement Grants $565,801
93.224 Covid-19 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $559,076
16.321 Antiterrorism Emergency Reserve $474,000
14.241 Housing Opportunities for Persons with Aids $424,871
93.052 National Family Caregiver Support, Title Iii, Part E $424,262
93.268 Covid-19 Immunization Cooperative Agreements $419,698
93.994 Maternal and Child Health Services Block Grant to the States $413,165
14.267 Continuum of Care Program $373,111
93.645 Stephanie Tubbs Jones Child Welfare Services Program $336,741
17.259 Wia Youth Activities $324,159
93.889 National Bioterrorism Hospital Preparedness Program $273,122
17.278 Wia Dislocated Worker Formula Grants $260,158
16.741 Dna Backlog Reduction Program $257,162
93.558 Temporary Assistance for Needy Families $252,064
93.044 Covid-19 Special Programs for the Aging_title Iii, Part B_grants for Supportive Services and Senior Centers $246,983
20.106 Airport Improvement Program $241,414
93.498 Covid-19 Provider Relief Fund $228,271
10.025 Plant and Animal Disease, Pest Control, and Animal Care $200,951
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $190,841
93.053 Nutrition Services Incentive Program $177,299
93.977 Cdc's Collaboration with Academia to Strengthen Public Health $177,086
14.231 Emergency Solutions Grant Program $171,536
93.268 Immunization Cooperative Agreements $165,572
14.231 Covid-19 Emergency Solutions Grant Program $156,533
93.470 Alzheimer's Disease Program Initiative (adpi) $151,621
20.106 Covid-19 Airport Improvement Program $148,000
16.320 Services for Trafficking Victims $147,663
93.052 Covid-19 National Family Caregiver Support, Title Iii, Part E $138,365
93.778 Medical Assistance Program $138,266
14.239 Home Investment Partnerships Program $137,644
10.904 Watershed Protection and Flood Prevention $136,354
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $131,167
16.575 Crime Victim Assistance $130,307
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $127,827
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $125,858
93.150 Projects for Assistance in Transition From Homelessness (path) $113,072
93.566 Refugee and Entrant Assistance_state Administered Programs $112,403
21.023 Covid-19 Emergency Rental Assistance Program $110,541
93.354 Covid-19 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $107,445
16.753 Congressionally Recommended Awards $104,331
16.833 National Sexual Assault Kit Initiative $90,347
10.555 National School Lunch Program $85,039
17.277 Covid-19 Workforce Investment Act (wia) National Emergency Grants $78,804
93.917 Hiv Care Formula Grants $78,205
20.507 Federal Transit_formula Grants $76,130
97.044 Assistance to Firefighters Grant $74,097
16.838 Comprehensive Opioid Abuse Site-Based Program $71,972
17.258 Wia Adult Program $64,672
93.071 Medicare Enrollment Assistance Program $60,000
10.704 Law Enforcement Agreements $57,892
93.043 Special Programs for the Aging_title Iii, Part D_disease Prevention and Health Promotion Services $57,532
20.616 National Priority Safety Programs $55,684
16.590 Grants to Encourage Arrest Policies and Enforcement of Protection Orders Program $52,377
84.126 Rehabilitation Services_vocational Rehabilitation Grants to States $52,083
16.922 Equitable Sharing Program $51,022
93.042 Special Programs for the Aging_title Vii, Chapter 2_long Term Care Ombudsman Services for Older Individuals $50,332
21.009 Volunteer Income Tax Assistance (vita) Matching Grant Program $48,657
10.553 School Breakfast Program $44,525
93.323 Covid-19 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $44,154
10.665 Schools and Roads - Grants to States $44,039
93.045 Covid-19 Special Programs for the Aging_title Iii, Part C_nutrition Services $43,668
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $38,478
16.U01 Eradication Suppression Fy 2022 Dea Domestic Cannabis Eradication Suppression Program $33,722
93.967 Cdc's Collaboration with Academia to Strengthen Public Health $32,930
16.607 Bulletproof Vest Partnership Program $31,474
17.277 Workforce Investment Act (wia) National Emergency Grants $30,628
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $30,331
14.218 Community Development Block Grants/entitlement Grants $30,000
93.918 Grants to Provide Outpatient Early Intervention Services with Respect to Hiv Disease $29,566
97.042 Emergency Management Performance Grants $25,944
93.069 Public Health Emergency Preparedness $25,741
93.626 Covid-19 Affordable Care Act State Health Insurance Assistance Program (ship) and Aging and Disability Resource Center (adrc) Options Counseling for Medicare-Medicaid Individuals in States with Approved Financial Alignment Models $23,349
16.710 Public Safety Partnership and Community Policing Grants $19,349
17.235 Senior Community Service Employment Program $17,564
16.738 Edward Byrne Memorial Justice Assistance Grant Program $11,138
93.048 Special Programs for the Aging_title Iv_and Title Ii_discretionary Projects $10,000
20.608 Minimum Penalties for Repeat Offenders for Driving While Intoxicated $8,015
15.664 Fish and Wildlife Coordination and Assistance Programs $7,610
93.041 Special Programs for the Aging_title Vii, Chapter 3_programs for Prevention of Elder Abuse, Neglect, and Exploitation $6,863
21.016 Equitable Sharing $5,828
45.310 Grants to States $5,000
93.747 Covid-19 Elder Abuse Prevention Interventions Program $4,382
15.904 Historic Preservation Fund Grants-in-Aid $4,000
16.742 Paul Coverdell Forensic Sciences Improvement Grant Program $3,606
14.228 Covid-19 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $2,874
16.U01 Eradication Suppression Fy 2023 Dea Domestic Cannabis Eradication Suppression Program $1,824
93.324 State Health Insurance Assistance Program $750
20.600 State and Community Highway Safety $90