FAC Explorer

Finding 504347 (2023-004)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2023
Accepted
2024-10-31
Audit: 326910
Organization: Kodiak Area Native Association (AK)
Auditor: Bdo USA PC

AI Summary

  • Core Issue: Two patients received discounts without approved applications to verify their ability to pay, violating 42 CFR 51c.303.
  • Impacted Requirements: The lack of proper documentation puts the agency at risk of noncompliance, potentially leading to funding reductions.
  • Recommended Follow-Up: Management should enhance processes to ensure all sliding fee scale applications are properly retained and approved before applying discounts.

Finding Text

Finding 2023-004 Special Tests and Provisions - Noncompliance and Significant Deficiency in Internal Control Over Compliance Agency Department of Health and Human Services Assistance Listing Numbers (ALN) and Program Name 93.224 & 93.527 Health Center Program Cluster – Health Center Program/ Grants for New and Expanded Services under the Health Center Program Criteria or Specific Requirement 42 CFR 51c.303 sets forth that community health centers are to have prepared a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts adjusted on the basis of the patient's ability to pay. Condition There were two patients who received discounts for sliding fee scale adjustments where there was not an approved application on file for the period in which they received services to document their ability to pay. Cause The Association's controls over retention and review of sliding fee scale applications for dental-related charges were insufficient. Effect or Potential Effect The Association is not compliant with 42 CFR 51c.303. The Association could be exposed to a reduction or elimination of funds by the Federal awarding agencies. Questioned costs Not applicable. Context There were two exceptions in the amount of $504 out of 29 items and $5,148 tested related to the Dentrix system adjustments. There were no exceptions to the 12 items and $2,164.33 tested for Cerner charges. Two additional items selected (totaling $206) from Dentrix were tested with no exception. Identification as a repeat finding Not a repeat finding. Recommendation Management should review existing processes and controls to ensure applications that document the patient’s ability to pay are retained and approved prior to applying any adjustments. Views of responsible officials Management concurs with this finding. Management plans to review adjustments to patient revenue on a quarterly basis.

Corrective Action Plan

Finding 2023-004 Special Tests and Provisions - Noncompliance and Internal Control Over Compliance – Significant Deficiency Planned Corrective Action 1. The Association will review the process and procedures associated with preparing a schedule of fees or payments for the provision of its services designed to cover its reasonable costs of operation and a corresponding schedule of discounts adjusted on the basis of the patient's ability to pay in accordance with 42 CFR 51c.303. Anticipated Completion date – December 31, 2024 2. The Association will review the process and procedures associated with obtaining an approved application from patients to be placed on file for the period in which the Association provides services to document patients ability to pay. Anticipated Completion date – December 31, 2024 3. The Association will review adjustments to patient revenue on a quarterly basis to ensure appropriate documentation for patients receiving adjustments have approved applications in place as required by policy and procedures. Anticipated Completion date – December 31, 2024

Categories

Special Tests & Provisions Significant Deficiency Internal Control / Segregation of Duties

Other Findings in this Audit

  • 504337 2023-005
    Significant Deficiency
  • 504338 2023-005
    Significant Deficiency
  • 504339 2023-005
    Significant Deficiency
  • 504340 2023-005
    Significant Deficiency
  • 504341 2023-005
    Significant Deficiency
  • 504342 2023-005
    Significant Deficiency
  • 504343 2023-005
    Significant Deficiency
  • 504344 2023-005
    Significant Deficiency
  • 504345 2023-003
    Significant Deficiency
  • 504346 2023-003
    Significant Deficiency
  • 504348 2023-004
    Significant Deficiency
  • 1080779 2023-005
    Significant Deficiency
  • 1080780 2023-005
    Significant Deficiency
  • 1080781 2023-005
    Significant Deficiency
  • 1080782 2023-005
    Significant Deficiency
  • 1080783 2023-005
    Significant Deficiency
  • 1080784 2023-005
    Significant Deficiency
  • 1080785 2023-005
    Significant Deficiency
  • 1080786 2023-005
    Significant Deficiency
  • 1080787 2023-003
    Significant Deficiency
  • 1080788 2023-003
    Significant Deficiency
  • 1080789 2023-004
    Significant Deficiency
  • 1080790 2023-004
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.527 Affordable Care Act (aca) Grants for New and Expanded Services Under the Health Center Program $2.47M
15.U02 Public Law 102-477 Program $1.56M
93.224 Consolidated Health Centers (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $832,724
93.654 Indian Health Service Behavioral Health Programs $569,948
15.021 Consolidated Tribal Government Program $553,393
84.250 American Indian Vocational Rehabilitation Services $525,767
93.210 Tribal Self-Governance Program: Ihs Compacts/funding Agreements $432,957
16.841 Voca Tribal Victim Services Set-Aside Program $399,982
93.237 Special Diabetes Program for Indians_diabetes Prevention and Treatment Projects $283,441
16.589 Rural Domestic Violence, Dating Violence, Sexual Assault, and Stalking Assistance Program $282,671
93.958 Block Grants for Community Mental Health Services $256,473
93.526 Affordable Care Act (aca) Grants for Capital Development in Health Centers $247,446
15.020 Aid to Tribal Governments $238,819
93.558 Temporary Assistance for Needy Families $232,078
15.144 Indian Child Welfare Act_title II Grants $210,751
93.788 Opioid Str $194,715
93.653 Indian Health Service Domestic Violence Prevention Programs $165,382
66.926 Indian Environmental General Assistance Program (gap) $129,607
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $110,292
93.671 Family Violence Prevention and Services/domestic Violence Shelter and Supportive Services $107,451
93.800 Organized Approaches to Increase Colorectal Cancer Screening $100,417
15.156 Cooperative Landscape Conservation $99,299
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $94,304
11.302 Economic Development_support for Planning Organizations $76,667
93.556 Promoting Safe and Stable Families $76,204
66.472 Beach Monitoring and Notification Program Implementation Grants $55,752
16.758 Improving the Investigation and Prosecution of Child Abuse and the Regional and Local Children's Advocacy Centers $55,160
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $51,282
93.054 National Family Caregiver Support, Title Vi, Part C, Grants to Indian Tribes and Native Hawaiians $50,604
45.311 Native American and Native Hawaiian Library Services $41,111
93.497 Family Violence Prevention and Services/ Sexual Assault/rape Crisis Services and Supports $27,767
16.710 Public Safety Partnership and Community Policing Grants $27,235
93.665 Emergency Grants to Address Mental and Substance Use Disorders During Covid-19 $25,704
20.205 Highway Planning and Construction $25,583
66.812 Hazardous Waste Management Grant Program for Tribes $23,006
10.575 Farm to School Grant Program $15,950
11.431 Climate and Atmospheric Research $14,259
84.181 Special Education-Grants for Infants and Families $14,171
66.202 Congressionally Mandated Projects $14,012
93.071 Medicare Enrollment Assistance Program $10,191
93.053 Nutrition Services Incentive Program $5,258
15.030 Indian Law Enforcement $4,496
93.645 Stephanie Tubbs Jones Child Welfare Services Program $923
93.047 Special Programs for the Aging_title Vi, Part A, Grants to Indian Tribes_part B, Grants to Native Hawaiians $29