Community Health Partners, Inc.

Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we noted instances where no supporting eligibility application and income verification were maintained by Community Health Partners, Inc. (the Clinic) to support the sliding fee scale discount adjustment that the patient received. Criteria: The sliding fee scale discount is based on patient income and demographic information. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in improper client billing and loss of revenue. Context: The Clinic did not maintain an eligibility application and income verification for 3 out of 40 patients tested. Cause: The Clinic had no form of secondary review in place, resulting in the errors in improper documentation not being detected and corrected in a timely manner. Recommendation: We recommend a secondary review of the applications and system input to ensure the proper documentation is verified in the electronic health records to support the slide eligibility. Management response: See Corrective Action Plan.

Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures over the UDS report, it was identified that the number of visits reported for physicians was overstated, while those for Nurse Practitioners (NPs) were understated. This discrepancy was due to a system error that incorrectly classified NPs as physicians. Criteria: Accurate reporting of service utilization by specific provider types is crucial for compliance with Department of Health and Human Services guidelines. Effect: Misclassification could lead to non-compliance with grant reporting requirements, potentially affecting the Clinic’s funding and accuracy of statistical data used for healthcare planning and resource allocation. Context: An analysis of visit data revealed that a system coding error led to incorrect provider type attribution where several NPs were recorded as physicians. Cause: Review of the report detected the error but it was not corrected in the final submission. Recommendation: We recommend an immediate review and correction of the errors noted in the accuracy report be completed prior to submission. Management Response: See Corrective Action Plan.

Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we noted an instance that payroll was processed without prior approval from the Chief Executive Officer (CEO) or Chief financial Officer (CFO), which is a violation of the Clinic's internal control policies. Criteria: The Clinic's internal control policies require that all payroll transactions be approved by either the CEO or the CFO before processing to ensure accuracy and compliance with budgetary allocations. Effect: The absence of proper approval could lead to unauthorized or erroneous payroll transactions, potentially resulting in financial misstatements and non-compliance with internal control requirements. This could also affect the Clinic’s financial integrity and accountability. Context: The approval for payroll processing was missing for one out of five payroll periods tested. Cause: The established pre-approval process was inadvertently bypassed by the payroll department staff. Recommendation: We recommend the implementation of a mandatory approval feature within the payroll system that requires sign-off by the CEO or CFO before payroll can be processed. Additionally, training should be provided to all payroll staff on the importance of adhering to internal control policies. Regular audits of payroll approvals should also be instituted to ensure compliance with the policy. Management Response: See Corrective Action Plan.

#2022-002 ? Grant Program: Department of Health and Human Services Health Centers Cluster ? Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we found two errors in the sliding fee category. In one instance, a patient was improperly billed for a sliding fee level they were not eligible for based on support provided with their application. In the second instance, no supporting eligibility application and income verification were maintained by the Clinic to support the sliding fee scale adjustment the patient received. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in improper client billing and loss of revenue. Context: During our testing, we found 2 of the 40 patients tested were not billed for the proper slide category based on the FY2022 sliding fee scale provided by the Clinic. No questioned costs were identified. Cause: The Clinic had no form of secondary review in place, resulting in the errors in billing or improper documentation not being detected and corrected in a timely manner. Recommendation: We recommend a secondary review of the applications and system input to ensure the patient is placed into and billed for the correct slide category within the software and proper documentation is verified in the electronic health records to support the slide eligibility. Management Response: See Corrective Action Plan.

Grant Program: Department of Health and Human Services Health Centers Cluster – Assistance Listing # 93.224/93.527 Condition: As a result of our audit procedures, we found two errors in the sliding fee category. In one instance, a patient was improperly billed for a sliding fee level they were not eligible for based on support provided with their application. In the second instance, no supporting eligibility application and income verification were maintained by the Clinic to support the sliding fee scale adjustment the patient received. Criteria: The sliding fee scale discount is based on patient income and demographic information. Controls should be in place to ensure the sliding fee scale is consistently applied for each patient. Effect: Continued non-compliance could result in a loss of funding. Additionally, it could result in improper client billing and loss of revenue. Context: During our testing, we found 2 of the 40 patients tested were not billed for the proper slide category based on the FY2022 sliding fee scale provided by the Clinic. No questioned costs were identified. Cause: The Clinic had no form of secondary review in place, resulting in the errors in billing or improper documentation not being detected and corrected in a timely manner. Recommendation: We recommend a secondary review of the applications and system input to ensure the patient is placed into and billed for the correct slide category within the software and proper documentation is verified in the electronic health records to support the slide eligibility. Management Response: See Corrective Action Plan.