The Joseph P. Addabbo Family Health Center, Inc.

Section III - Federal Award Findings and Questioned Costs Finding 2025-001 - Procurement, Suspension and Debarment - Significant Deficiency Name of Federal Agency: U.S. Department of Health and Human Services Federal Program Name: Health Center Program Cluster: Health Center Program and Grants for New and Expanded Services Under the Health Center Program Assistance Listing Number: 93.224 and 93.527 Federal Award Identification Number and Year: Health Center Program Cluster: H80CS00430 - 2023 and H80CS00430 - 2024 Criteria In accordance with §200.213 and §180.300, nonfederal entities cannot enter into awards, subawards, or contracts with certain parties that are debarred, suspended, or otherwise excluded from or ineligible for participation in federal assistance programs or activities. Condition During our testing, we noted that the Center did not perform a timely check at the System for Award Management Exclusions (SAM.gov) to verify whether a vendor had been suspended or debarred being hired. Cause The Center did not have adequate policies, procedures, and controls in place to ensure compliance with the suspension and debarment requirements. Effect or Potential Effect Failure to timely verify that a vendor is not suspended or debarred could result in hiring a vendor on federal grant programs that is barred from performing work for the U.S. government. Questioned Costs None. Context For two suspension and debarment samples out of a total of two tested, management did not provide evidence that a check at sam.gov was performed during year under audit. Recommendation We recommend that the Center perform a check at sam.gov prior to the hire of vendor to ensure the vendor was not suspended or debarred and retain evidence of that verification, including the date it was performed. We also recommend a check at sam.gov be done annually thereafter and evidence of that verification be maintained. Views of Responsible Officials The Center now uses Sreamline Verify, an online software, which searches each vendor before they are hired. There is also a monthly search performed for all vendors.

Section III - Federal Award Findings and Questioned Costs Finding 2024-001 - Procurement, Suspension and Debarment - Significant Deficiency Name of Federal Agency: U.S. Department of Agriculture Federal Program Name: WIC Special Supplemental Nutrition Program for Women, Infants, and Children Assistance Listing Number: 10.557 Federal Award Identification Number and Year: 244NY704W1003; 2023-2024 and 2024-2025 Name of Pass-through Entity: New York State Department of Health Criteria In accordance with §200.213 and §180.300, nonfederal entities cannot enter into awards, subawards, or contracts with certain parties that are debarred, suspended, or otherwise excluded from or ineligible for participation in federal assistance programs or activities. Condition During our testing, we noted that the Center did not perform a timely check at the System for Award Management Exclusions (SAM.gov) to verify whether an employee had been suspended or debarred before being hired. Cause The Center did not have adequate policies, procedures, and controls in place to ensure compliance with the suspension and debarment requirements. Effect or Potential Effect Failure to timely verify that an employee is not suspended or debarred could result in hiring an employee to work on federal grant programs that is barred from performing work for the U.S. government. Questioned Costs None. Context For four suspension and debarment samples out of a total of four tested, management did not provide evidence that a check at sam.gov was performed before hiring. Recommendation We recommend that the Center establish written suspension and debarment policies and procedures to ensure that the Center is in compliance with the Uniform Guidance and that all staff are trained on this policy to ensure compliance and related internal controls over compliance are operating effectively. Views of Responsible Officials Our current protocol requires conducting SAM.gov exclusion checks on or before the hire date. However, due to recent administrative transition, some records from 2025 and prior were found to be unavailable. To address this gap, we have re-verified SAM.gov checks for all new hires in 2025 and will continue performing monthly exclusion checks moving forward. All SAM.gov results will be stored electronically to ensure ongoing compliance and proper documentation.

Section III - Federal Award Findings and Questioned Costs U.S. Department of Health and Human Services: Health Centers Program Cluster (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) (Assistance Listing Number 93.224) and Grants for New and Expanded Services Under the Health Center Program (Assistance Listing Number 93.527). Finding 2022-001 - Special Tests and Provisions: Sliding Fee Discounts Criteria In accordance with 42 CFR sections 51c.303(f) and (g), health centers must prepare and apply a sliding fee discount schedule ("SFDS") so that the amounts paid for health center services by eligible patients are adjusted (discounted) based on the patient's ability to pay. Statement of Condition During our audit, we noted that the SFDS was not properly applied to a patient due to an error made by the patient services representative. Questioned costs None Cause The patient services representative did not record within the billing system, the patient's household income and number of dependents. Effect The amounts owed for the services provided were not based on the Center's SFDS. Context One exception from a statistically valid sample of 25. Identification of Repeat Finding No Recommendation We recommend that proper training be given to the patient services representatives, and the sliding fee discounts be reviewed by a supervisor on a periodic basis to ensure compliance. Management Response All supervisors were mandated to conduct training sessions for all staff members involved in patient registration and billing processes. The Center has improved communication between the registration and billing personnel, to ensure that patient information and financial details are accurately shared to minimize the risk of errors. The Center is in the process of updating its documentation processes to include clear guidelines on handling sliding fee scale patients, along with mandatory checklists to ensure all steps are followed correctly.

Section II - Financial Statement Findings None Section III - Federal Award Findings and Questioned Costs U.S. Department of Health and Human Services: Consolidated Health Centers (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care) (CFDA 93.224) and Affordable Care Act (ACA) Grants for New and Expanded Services Under the Health Center Program (CFDA 93.527) Finding 2019-001 ? Special Tests and Provisions: Sliding Fee Discounts Criteria In accordance with 42 CFR sections 51c.303(f) and (g), health centers must prepare and apply a sliding fee discount schedule ("SFDS") so that the amounts paid for health center services by eligible patients are adjusted (discounted) based on the patient's ability to pay. Statement of Condition During our review of the Center's application of the SFDS, the amounts charged to 2 patients were not in accordance with the Center's SFDS. Questioned Costs None Cause The registration personnel did not accurately apply the SFDS. Effect The amounts owed for the services provided were not based on the Center's SFDS. Context Not considered an isolated incident. 2 exceptions from a statistically valid sample of 25. Identification as Repeat Finding No Recommendation We recommend that the sliding fee discounts be monitored and reviewed by a supervisor on a periodic basis to ensure compliance. Management Response Senior Clinical and Executive management reviewed the details specific to these 2 patients, and have randomly performed spot checks on the sliding fee scales in use throughout the Center, simultaneously making inquiries of front office staff to assess their understanding and practical application of the sliding fee discount policy. The results of these initial actions were discussed among the senior management team, collectively deciding that educational trainings are necessary. As a reinforcing action, senior management also decided that these trainings would be conducted throughout the 4th quarter, and intends to repeat the training early in the 1st quarter of 2021, shortly after the sliding fee discount schedules are updated for the new Federal Poverty Guidelines.