EIN: 481221800
UEI: FCN3YXWSDC36
Audited by: CohnReznick LLP
Oversight agency: 93 [Department of Health and Human Services]
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Data as of September 7, 2026
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on December 22, 2025. Under 2 CFR 200.521(d), a pass-through entity that provided federal funds to this organization for this audit period must issue a management decision on these findings by June 22, 2026 (80 days ago).
What is a management decision? →Finding 2025.002: Special Tests and Provisions - Sliding Fee Discounts - Significant Deficiency Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster, Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care, Grants for New and Expanded Services under the Health Center Program, COVID-19 Grants for New and Expanded Services under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Federal Award Identification Number and Year: H80CS24170-13-00 and 2024 Criteria Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5), 56.108(b)(5) and 56.303(f)). The Organization should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Organization's sliding fee scale. Condition The Organization did not always appropriately apply the sliding fee discount based on income levels. Cause The Organization did not have adequate internal controls in place to effectively ensure that patients receive the correct sliding fee discount. Effect or Potential Effect The Organization did not comply with the appropriate rules and regulations as per the Uniform Guidance. Questioned Costs None. Context A test of 40 slide fee discount transactions was performed and resulted in one instance of a sliding fee discount not being properly calculated based on the respective patient family size and income or was not in agreement with the supporting documentation. Our sample was a statistically valid sample. Identification as a Repeat Finding Not a repeat finding. Recommendation The Organization should strengthen internal controls in place to effectively ensure that patients receive the correct sliding fee discount. Views of Responsible Officials and Planned Corrective Actions Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.
Show full finding ▾Hide full finding ▴Finding 2025.002: Special Tests and Provisions - Sliding Fee Discounts - Significant Deficiency Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster, Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care, Grants for New and Expanded Services under the Health Center Program, COVID-19 Grants for New and Expanded Services under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Federal Award Identification Number and Year: H80CS24170-13-00 and 2024 Criteria Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5), 56.108(b)(5) and 56.303(f)). The Organization should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Organization's sliding fee scale. Condition The Organization did not always appropriately apply the sliding fee discount based on income levels. Cause The Organization did not have adequate internal controls in place to effectively ensure that patients receive the correct sliding fee discount. Effect or Potential Effect The Organization did not comply with the appropriate rules and regulations as per the Uniform Guidance. Questioned Costs None. Context A test of 40 slide fee discount transactions was performed and resulted in one instance of a sliding fee discount not being properly calculated based on the respective patient family size and income or was not in agreement with the supporting documentation. Our sample was a statistically valid sample. Identification as a Repeat Finding Not a repeat finding. Recommendation The Organization should strengthen internal controls in place to effectively ensure that patients receive the correct sliding fee discount. Views of Responsible Officials and Planned Corrective Actions Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.
Finding 2025.002 - Sliding Fee Scale Discount Recommendation The Organization should strengthen internal controls in place to effectively ensure that patients receive the correct sliding fee discount. Action Taken • Monthly Audits o The Front Office Coordinators at each location will routinely audit sliding fee verification on a monthly basis to verify that information has been captured and recorded correctly and all proof of income documentation is received. These monthly audits will be adopted as standard protocol and procedure for front office operations, effective January 2025. Any findings through the audit process will be reported to the COO. At least five patient charts will be audited monthly. o In addition, the Revenue Cycle Manager will also review audit findings or summaries to ensure adequate adjustment to patient accounts to correlate with the patient's eligibility status. • Staff Training o Although Heartland has offered periodic sliding fee scale procedure training, administration will be scheduling additional training with a focus on required documentation and proper analysis and implementation of sliding fee discounts. o COO and Revenue Cycle Manager will review, implement and update standard operating procedure for sliding fee scale verification. o Employees will receive a copy of the sliding fee scale policy and sign that they have read the material. o Front office employees at all locations will complete a sliding fee schedule competency check-off sheet that will be reviewed by the Front Office Coordinators and Revenue Cycle Manager.
FAC accepted this audit on March 21, 2025 — management decision was due September 21, 2025.
FAC accepted this audit on January 23, 2024 — management decision was due July 23, 2024.
Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster: Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), COVID-19 Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), Grants for New and Expanded Services under the Health Center Program, COVID-19 Grants for New and Expanded Services under the Health Center Program Finding 2023.001: Sliding Fee Scale Documentation Federal Assistance Listing Numbers: 93.224 and 93.527 Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5), 56.108(b)(5) and 56.303(f)). The Organization should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Organization's sliding fee scale. Condition The Organization did not always have the proper slide fee documentation readily available to ensure the proper slide fee discount was applied based on approved policies. Cause The Organization did not have adequate internal controls in place to effectively ensure that all sliding fee discounts were properly calculated based on approved documentation. Context A test of 40 sliding fee discount transactions was performed and resulted in 2 instances where the Organization was unable to provide approved documentation. Our sample was a statistically valid sample. Questioned Costs None Effect The Organization did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification of Repeat Finding Yes Recommendation The Organization should establish a system of internal controls to ensure that all sliding fee discounts are properly calculated and supported based on family size and income. Views of Responsible Officials and Planned Corrective Actions Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency. Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5), 56.108(b)(5) and 56.303(f)). The Organization should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Organization's sliding fee scale.
Show full finding ▾Hide full finding ▴Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster: Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), COVID-19 Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), Grants for New and Expanded Services under the Health Center Program, COVID-19 Grants for New and Expanded Services under the Health Center Program Finding 2023.001: Sliding Fee Scale Documentation Federal Assistance Listing Numbers: 93.224 and 93.527 Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5), 56.108(b)(5) and 56.303(f)). The Organization should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Organization's sliding fee scale. Condition The Organization did not always have the proper slide fee documentation readily available to ensure the proper slide fee discount was applied based on approved policies. Cause The Organization did not have adequate internal controls in place to effectively ensure that all sliding fee discounts were properly calculated based on approved documentation. Context A test of 40 sliding fee discount transactions was performed and resulted in 2 instances where the Organization was unable to provide approved documentation. Our sample was a statistically valid sample. Questioned Costs None Effect The Organization did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification of Repeat Finding Yes Recommendation The Organization should establish a system of internal controls to ensure that all sliding fee discounts are properly calculated and supported based on family size and income. Views of Responsible Officials and Planned Corrective Actions Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency. Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of patients' ability to pay and their eligibility. A patient's eligibility to pay is determined on the basis of the official poverty guideline, as revised by DHHS (42 CFR Sections 51c, 107(b)(5), 56.108(b)(5) and 56.303(f)). The Organization should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Organization's sliding fee scale.
To United States Department of Health and Human Services Heartland Community Health Center respectfully submits the following corrective action plan for the year ended April 30, 2023. CohnReznick, LLP 350 Church Street Hartford, CT 06103 Audit Period: April 30, 2023 The findings from the April 30, 2023 schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the number assigned in the schedule. Federal Awards Findings: Finding 2023.001 - Sliding Fee Scale Discount Recommendation The Organization should establish a system of internal controls to ensure that all sliding fee discounts are properly calculated and supported based on family size and income. Action Taken • Monthly Audits o The Front Office Coordinators at each location will routinely audit sliding fee verification on a monthly basis to verify that information has been captured and recorded correctly and all proof of income documentation is received. These monthly audits will be adopted as standard protocol and procedure for front office operations, effective January 2024. Any findings through the audit process will be reported to the COO. At least five patien.t charts will be audited monthly. o In addition, the billing manager will also review audit findings or summaries to ensure adequate adjustment to patient accounts to correlate with the patient's eligibility status. • Staff Training o Although Heartland has offered periodic sliding fee scale procedure training, administration will be scheduling additional training with a focus on required documentation and proper set up of sliding fee discounts. o Health Center Practice Administrator will review and implement and update standard operating procedure for sliding fee scale verification. o Employees will receive a copy of the sliding fee scale policy and sign that they have read the material. o Front office employees at all locations will complete a sliding fee schedule competency check-off sheet that will be reviewed by the Front Office Coordinators and billing manager. If there are any question regarding this plan, please e-mail Regina Oxford at roxford@heartlandhealth.org. Sincerely,
2022-001
FAC accepted this audit on January 29, 2023 — management decision was due July 29, 2023.
Finding 2022.001: Sliding Fee Scale Documentation Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster: Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), Grants for New and Expanded Services under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Criteria In accordance with the Uniform Guidance, the Organization must prepare and apply a sliding fee discount policy and schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on a patient's poverty level, which is determined by the patient's income and family size. Condition The Organization did not always have the proper documentation on file to support the patient's income and family size. Context A test of 25 sliding fee discount transactions was performed and resulted in 15 instances where the Organization was unable to provide approved documentation. Our sample was a statistically valid sample. Questioned Costs None. Cause The Organization did not have adequate internal controls in place to effectively ensure that the proper sliding fee discount information is on file and illustrates the appropriate discount based on the Organization's sliding fee discount policy. Effect The Organization did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification of Repeat Finding No. Recommendation The Organization should establish a system of internal controls to ensure that all sliding fee discounts are properly supported. Views of Responsible Officials and Planned Corrective Actions Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.
Show full finding ▾Hide full finding ▴Finding 2022.001: Sliding Fee Scale Documentation Grantor: U.S. Department of Health and Human Services Federal Program Names: Health Center Program Cluster: Health Center Program (Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care), Grants for New and Expanded Services under the Health Center Program Federal Assistance Listing Numbers: 93.224 and 93.527 Criteria In accordance with the Uniform Guidance, the Organization must prepare and apply a sliding fee discount policy and schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on a patient's poverty level, which is determined by the patient's income and family size. Condition The Organization did not always have the proper documentation on file to support the patient's income and family size. Context A test of 25 sliding fee discount transactions was performed and resulted in 15 instances where the Organization was unable to provide approved documentation. Our sample was a statistically valid sample. Questioned Costs None. Cause The Organization did not have adequate internal controls in place to effectively ensure that the proper sliding fee discount information is on file and illustrates the appropriate discount based on the Organization's sliding fee discount policy. Effect The Organization did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification of Repeat Finding No. Recommendation The Organization should establish a system of internal controls to ensure that all sliding fee discounts are properly supported. Views of Responsible Officials and Planned Corrective Actions Management agrees with the audit finding and will strengthen internal controls and accountability to correct the deficiency.
Corrective Action Plan Year Ended April 30, 2022 To United States Department of Health and Human Services Heartland Community Health Center respectfully submits the following corrective action plan for the year ended April 30, 2022. CohnReznick, LLP 350 Church Street Hartford, CT 06103 Audit Period: April 30, 2022 The findings from the April 30, 2022 schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the number assigned in the schedule. Federal Awards Findings: Finding 2022.001 - Sliding Fee Scale Discount Recommendation The Center should establish a system of internal controls to ensure that all sliding fee discounts are properly calculated. Action Taken ? Monthly Audits o The immediate supervisor of front office operations will routinely audit sliding fee verification on a monthly basis to verify that information has been captured and recorded correctly. These monthly audits will be adopted as standard protocol and procedure for front office operations, effective January 2023. Any findings through the audit process will be reported to the COO. At least five patient charts will be audited monthly. o In addition, the billing manager will also review audit findings or summaries to ensure adequate adjustment to patient accounts to correlate with the patient?s eligibility status. ? Staff Training o Although Heartland has offered periodic sliding fee scale procedure training, administration will be scheduling additional trainings with a focus on required documentation and proper set up sliding fee. o Supervisor of front office operations will review and implement and update standard operating procedure for sliding fee scale verification. o Employees will receive a copy of the sliding fee scale policy and sign that they have read the material. o Front office employees at all locations will complete a sliding fee schedule competency check-off sheet that will be reviewed by the immediate supervisor and billing manager. If there are any question regarding this plan, please e-mail Scott Burcher at sburcher@heartlandhealth.org. Sincerely, Scott Burcher Chief Financial Officer
FAC accepted this audit on June 22, 2022 — management decision was due December 22, 2022.
FAC accepted this audit on January 5, 2021 — management decision was due July 5, 2021.
FAC accepted this audit on October 1, 2019 — management decision was due April 1, 2020.
2019-001 Health Center Program Cluster CFDA No. 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS24170-07-07 Program Year 2019 Criteria or Specific Requirement ? Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR Sections 51c. 303(g); and 42 CFR Sections 56.303(f)) Condition ? The formal sliding fee discount policy includes language that is noncompliant with the Health Center Program Compliance Manual. Inappropriate sliding fee adjustments were given due to noncompliance with the Organization?s sliding fee discount program. Eligibility information was not accurately input into the practice management system, resulting in errors in assignment of sliding fee pay classes. Questioned Costs ? None Context ? A sample of 40 encounters were tested out of the total population of 27,255 encounters. The sampling methodology used is not and is not intended to be statistically valid. Four patients did not receive the proper sliding fee adjustment due to noncompliance with the Organization?s sliding fee discount program or errors in application of the Organization?s sliding fee discount program. Effect ? Patients were potentially not given proper sliding fee discounts. Cause ? The Organization?s sliding fee policy is noncompliant with the Health Center Program Compliance Manual. Internal control over compliance is not sufficient to ensure compliance with the Organization?s sliding fee policy. Identification as a repeat finding, if applicable ? Repeat finding ? Finding 2018-003 Recommendation ? Management should modify the sliding fee policy to ensure compliance with the Health Center Program Compliance Manual. Management should implement an internal audit process or other controls to monitor and ensure compliance with the sliding fee policy.
Show full finding ▾Hide full finding ▴2019-001 Health Center Program Cluster CFDA No. 93.527 U.S. Department of Health and Human Services Award No. 6 H80CS24170-07-07 Program Year 2019 Criteria or Specific Requirement ? Special Tests and Provisions: Sliding Fee Discounts (42 USC 254(k)(3)(g); 42 CFR Sections 51c. 303(g); and 42 CFR Sections 56.303(f)) Condition ? The formal sliding fee discount policy includes language that is noncompliant with the Health Center Program Compliance Manual. Inappropriate sliding fee adjustments were given due to noncompliance with the Organization?s sliding fee discount program. Eligibility information was not accurately input into the practice management system, resulting in errors in assignment of sliding fee pay classes. Questioned Costs ? None Context ? A sample of 40 encounters were tested out of the total population of 27,255 encounters. The sampling methodology used is not and is not intended to be statistically valid. Four patients did not receive the proper sliding fee adjustment due to noncompliance with the Organization?s sliding fee discount program or errors in application of the Organization?s sliding fee discount program. Effect ? Patients were potentially not given proper sliding fee discounts. Cause ? The Organization?s sliding fee policy is noncompliant with the Health Center Program Compliance Manual. Internal control over compliance is not sufficient to ensure compliance with the Organization?s sliding fee policy. Identification as a repeat finding, if applicable ? Repeat finding ? Finding 2018-003 Recommendation ? Management should modify the sliding fee policy to ensure compliance with the Health Center Program Compliance Manual. Management should implement an internal audit process or other controls to monitor and ensure compliance with the sliding fee policy.
FY 2019 Audit Deficiencies ? Views of Responsible Officials and Planned Corrective Action Heartland Medical Clinic takes seriously its responsibility for adequate internal controls and our response to audit finding follows below. Significant Deficiency ? Sliding Fee Discounts ? o Heartland will review its Sliding Fee Scale policies and procedures to ensure compliancy by January 2020. It intends to simplify the sliding fee scale for staff to be able to easily follow and document. The two errors found in the four deficient samples were related to an incorrect classification of uncollected fees between Bad Debt and Sliding Fee Scale and related to using the incorrect Sliding Fee Scale (regular SFS vs. Back-to-School SFS; preventive dental vs. disease control dental). By simplifying the sliding fee scale, Heartland expects to reduce errors significantly. o In regards to the previous year?s finding, Heartland has completed its corrective action plan it developed last year. In February 2019, Heartland revised its Sliding Fee Scale to remove the ?Other Fees? and ?Back to School Sliding Fee Scale? sections and added a section outlining a procedure to selfaudit 5 patient accounts each month. Heartland?s Patient Service Representative Supervisor began completing these self-audits in March 2019. Any deficiencies she finds are reviewed with PSR staff and ongoing training is provided. o The action plan is the responsibility of the COO, with the assistance of the Patient Services Supervisor. With best regards, /s/ Stephen M. Carttar Stephen M. Carttar, Interim CFO Sel/SMC
2018-003
FAC accepted this audit on January 13, 2019 — management decision was due July 13, 2019.
GSA_MIGRATION
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GSA_MIGRATION
FAC accepted this audit on January 30, 2018 — management decision was due July 30, 2018.
FAC accepted this audit on March 21, 2017 — management decision was due September 21, 2017.
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