AUDUBON AREA COMMUNITY CARE CLINIC, INC.Non-Profit

DEPARTMENT OF HEALTH AND HUMAN SERVICES 2025-001 Other Matter: Special Tests and Provisions: Sliding Fee Scale Applications Condition: During our audit, we selected a sample of 25 records for patients treated during the audit period to determine whether patient charges were appropriately adjusted based on income and family size by applying the health center’s sliding fee discount schedule. During our procedures, five sliding fee scale applications were not documented for patients receiving the sliding fee discount. Criteria: The Clinic is required to establish systems for determining and documenting sliding fee eligibility determination. Sliding fee scale applications serve as the key source documentation for documenting patients’ income and family size for eligibility determination. Sliding fee scale applications should be completed and maintained for all patients receiving the sliding fee scale discount. Cause: The five undocumented sliding fee scale applications were related to one staff member. The staff member did not follow up with the patients in a timely manner to document the sliding fee scale applications. Effect: Sliding fee discounts for the referenced five patients with undocumented sliding fee scale applications were not supported by adequate documentation to determine if the patients were eligible to receive the sliding fee scale discount. Recommendations: The staff member responsible for the undocumented sliding fee scale applications should be informed and trained on the Clinic’s documentation requirements for the sliding fee program. The Clinic should monitor the staff member to ensure the condition has been resolved. View of Responsible Officials and Planned Corrective Actions: Management agrees with the other matter. Corrective action has been taken. On October 23, 2025, Management informed the applicable staff member regarding the undocumented sliding fee scale applications identified during the audit. The staff member acknowledged the undocumented sliding fee scale applications. The staff member has been retrained on the sliding fee scale documentation requirements. Management will supervise and monitor the staff member to ensure the other matter has been resolved.

DEPARTMENT OF HEALTH AND HUMAN SERVICES 2025-002 Other Matter Special Tests and Provisions: Sliding Fee Discounts – Federal Poverty Guidelines Condition: During our audit, we selected a sample of 25 records for patients treated during the audit period to determine whether patient charges were appropriately adjusted based on income and family size by applying the Clinic’s board approved sliding fee discount scales. Although the Clinic timely updated its board-approved sliding fee scales to reflect the most recent FPGs, the electronic medical record (EMR) system does not automatically re-evaluate a patient’s discount level using the current FPGs at the date of service. Instead, the system locks the discount calculation to the FPG in effect on the date the patient’s income and family-size information was originally entered into the EMR. During our procedures, four sliding fee discounts did not use the correct FPGs to determine the sliding fee discount. Criteria: Sliding fee discounts should be determined based on the most recent FPGs at the date of service. Cause: The EMR uses the FPGs as of the date the sliding fee discount information was entered into the software instead of the FPG as of the date of service. Example: A patient’s sliding fee information is entered December 1, 2024. If the patient receives services during 2025, the EMR continues to calculate the sliding fee discount based on the 2024 FPG (when the sliding fee information was inputted into the software). Effect: Sliding fee discounts are calculated using outdated FPGs. Since the FPGs do not change significantly, most patient’s will still be within the same FPG range and charged the appropriate sliding fee discount, so there is no material (or significant) impact to the financial statements or compliance over the Clinic’s major federal program. Recommendations: While using outdated FPGs for sliding fee discounts will not result in a material misstatement to the financial statements or material noncompliance due to the nature of the issue, the Clinic should address to ensure the sliding fee discount program is being operated as required by the Health Center Program Compliance Manual and intended by the board of directors. View of Responsible Officials and Planned Corrective Actions: Management agrees with the other matter. Planned corrective action is in progress. Management has reached out to their EMR provider to discuss an implementation strategy to address the condition. Implementation of corrective action is expected to occur once the 2026 FPGs are released.

Reporting: UDS Reporting Errors Condition: The 2023 UDS Report contained errors, including line items containing “critical information” per the May 2023 Compliance Supplement. The UDS Report errors we identified are summarized below: UDS Report - 2023 Criteria: Health centers receiving federal award funds under the Health Center Program are required to submit an accurate Uniform Data System (UDS) report annually. Cause: The personnel responsible for preparing the UDS report was unfamiliar with the underlying documentation used to prepare the financial information presented above. Additionally, the reported amounts were not agreed to the Clinic’s financial statements. Effect: As a result of this error, some of the information presented in the UDS was materially incorrect. This could potentially affect the health center’s compliance with federal reporting requirements and mislead users of the UDS information. Furthermore, inaccurate financial data could impair HRSA’s monitoring of the health center’s programmatic and financial performance. Recommendations: The UDS preparer should gain an understanding of the underlying documentation used to report the correct information. In addition, the financial statements should be compared to the UDS for all financial amounts presented. Any reconciling items between the Clinic’s financial statements and UDS should be documented and explained. The Clinic may want to consider a secondary review of the financial information included in the UDS by a member of the finance team. View of Responsible Officials and Planned Corrective Actions: The Clinic will take the auditor’s recommendation under advisement.