Finding 555252 (2023-005)

Significant Deficiency Repeat Finding
Requirement
N
Questioned Costs
-
Year
2023
Accepted
2025-04-16
Audit: 353876
Organization: Community Health Service, Inc. (MN)

AI Summary

  • Core Issue: There is a significant deficiency in internal controls regarding the backup of sliding fee applications and income documents.
  • Impacted Requirements: Compliance with Title 2 U.S. Code of Federal Regulations Part 200 is not being met, risking incorrect sliding fee discounts for patients.
  • Recommended Follow-Up: Implement stronger internal controls to ensure compliance with the Uniform Guidance requirements.

Finding Text

U.S. Department of Health and Human Services Health Center Program Cluster- Health Center Program, Assistance Listing No. 93.224 Compliance Requirements: Special Tests and Provisions Type of Finding - Significant Deficiency in Internal Control over Compliance (Repeat Finding) Condition - Proper backup of sliding fee applications and supporting income level documents were not maintained or stored. Criteria - Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) requires that a non Federal entity 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. Cause - The Organization did not have internal controls to reasonably ensure compliance. Effect - Patients were potentially incorrectly given or not given proper sliding fee discounts. Context - A non statistical sample of 40 from a population of over 250 encounters was selected for testing. The proper supporting documents were not maintained for 3 encounters tested. Recommendation - We recommend the Organization implement internal controls to reasonably ensure its compliance with the requirements identified in Uniform Guidance. Management Response to Findings – Management concurs with the finding.

Corrective Action Plan

1. Improvement of Data Entry and Documentation Management: *The process for submitting, processing, and storing sliding fee applications will be reviewed and streamlined to ensure that all supporting income level documents are properly collected, verified, and stored at the time of application submission. *Employees involved in handling sliding fee applications and supporting documents will be provided with training on the importance of accurate documentation and the procedures for proper filing, both physically and electronically. 2. Implement Regular Monitoring and Auditing: *A regular internal review and audit process will be revisited to ensure that backup, storage, and retention practices are being followed. These audits will focus on verifying that all sliding fee applications and related documents are stored correctly and are retrievable as needed. *Any discrepancies or issues identified during audits will be addressed promptly, and corrective actions will be taken to ensure compliance with the established procedures. 3. Staff Training and Awareness: *Training sessions will be conducted for all relevant staff on the updated backup, storage, and retention procedures for sliding fee applications and income documentation. This training will emphasize the importance of maintaining accurate and accessible records to comply with regulatory and organizational standards. *Refresher training will be provided quarterly to ensure ongoing compliance and awareness.

Categories

Special Tests & Provisions Allowable Costs / Cost Principles Significant Deficiency Internal Control / Segregation of Duties

Other Findings in this Audit

  • 555251 2023-004
    Material Weakness Repeat
  • 555253 2023-004
    Material Weakness Repeat
  • 555254 2023-005
    Significant Deficiency Repeat
  • 555255 2023-004
    Material Weakness Repeat
  • 555256 2023-005
    Significant Deficiency Repeat
  • 555257 2023-004
    Material Weakness Repeat
  • 555258 2023-005
    Significant Deficiency Repeat
  • 555259 2023-004
    Material Weakness Repeat
  • 555260 2023-005
    Significant Deficiency Repeat
  • 555261 2023-004
    Material Weakness Repeat
  • 555262 2023-005
    Significant Deficiency Repeat
  • 1131693 2023-004
    Material Weakness Repeat
  • 1131694 2023-005
    Significant Deficiency Repeat
  • 1131695 2023-004
    Material Weakness Repeat
  • 1131696 2023-005
    Significant Deficiency Repeat
  • 1131697 2023-004
    Material Weakness Repeat
  • 1131698 2023-005
    Significant Deficiency Repeat
  • 1131699 2023-004
    Material Weakness Repeat
  • 1131700 2023-005
    Significant Deficiency Repeat
  • 1131701 2023-004
    Material Weakness Repeat
  • 1131702 2023-005
    Significant Deficiency Repeat
  • 1131703 2023-004
    Material Weakness Repeat
  • 1131704 2023-005
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
93.224 Health Center Program (community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) $152,237