Wesley Community Center, Inc

Condition: Wesley requires patients that apply for the SFS discount to complete attestation forms that includes their household sizes and income levels, and these forms are then used to determine patients SFS discounts . For five SFS encounter that we tested the patient income information was incorrectly entered into the patient management system and one SFS encounter was not updated for January 2024 HHS Poverty Guidelines.

Condition: Wesley requires that apply for the SFS discount to complete attestation forms that included their household sizes and income levels, and these forms are then used to determine patients SFS discounts . For one SFS encounter that we tested the attestation form was not completed and one SFS encounter has incorrect household income applied in the patient management system.

2022-101 Special Tests and Provisions - Sliding Fee Scale Discounts Federal Program: FAL#: 93.224 Health Center Program Cluster: Health Center Program U.S. Department of Health and Human Services Federal Grant Number: H80CS12848-VARIOUS Questioned Costs: None Criteria: Patients applying for sliding fee scale (SFS) discounts should have their income levels adequately documented and accurately calculated, and patients should be given the proper discount based upon their income level in accordance with 42CFR Section 51c.303(f). Condition: Wesley requires patients that apply for the SFS discount to complete attestation forms that includes their household sizes and income levels, and these forms are then used to determine patients' SFS discounts. Two SFS encounters that we tested had incorrectly calculated SFS discount applied in the patient management system. Cause: Unknown. Effect: For two of forty sliding fee patient encounters tested, Wesley utilized outdated Federal Poverty Guidelines to calculate FPL%; therefore those patients were not charged the correct copays in accordance with federal requirements. In addition, Wesley did not consistently update income levels for existing patients. Recommendation: To help ensure that sliding fee patient records are properly calculated and documented, Wesley should strictly adhere to its formal written policies and procedures, and conduct random reviews of sliding fee scale applications in order to detect and correct errors or incomplete applications on a timely manner.

System of Internal Controls-Accounts Payable/Cash Disbursements Criteria: Generally accepted accounting principles requires the Organization to maintain a system of internal controls to insure that transactions are accurately entered and that errors may be detected and corrected in a timely basis. The Organization utilizes an accounting policies and procedures manual as a guide to employees performing accounting functions. Condition: Certain internal control procedures relating to accounts payable and cash disbursements were not documented and therefore may or may not have been performed. Context: Wesley?s accounting policies and procedures manual includes a procedure for the clerk receiving supplies to review the packing slip and purchase order and match them to the items received. This ensures that only items authorized for purchase and actually received will be entered into the accounts payable system. Additionally, the check signer is required to match the purchase order, packing slip and invoice before signing the check for payment. Auditor tested 10 out of 147 general ledger transactions representing 38% of the expenditures in the medical supplies account. For each transaction tested, auditor found that there was no documentation showing that the receiving clerk in fact matched the purchase order and packing slip to the items received. In addition, there was no documentation to show that the check signer matched the purchase order, packing slip and invoice before signing the payment check. Effect: Unauthorized or unreceived items may have been expensed and paid for. Cause: Management did not monitor that internal control procedures relating to accounts payable and cash disbursements were being followed and documented. Recommendation: Management should review receiving procedures with receiving clerk and cash disbursement procedures with check signer to insure their understanding of the process. Management should monitor that the procedures are being performed and documented. Views of Responsible Officials and Planned Corrective Actions: Management agrees with the finding and provides further response in its corrective action plan.

Compliance with Grant Requirement (HRSA) Criteria: Health Center Program Compliance Manual (HCPCM), Staff Documentation Sections 330(a)(1), (b)(1) of the PHS Act and 42CFR 51c. 303(a), 42CFR 51c. 303(p), 42 CFR 56.30(a), 42 CFR 56.303(p) Context: Federally funded health care centers are required to comply with the HCPCM requirements. Auditor reviewed Chapter 5-Clinical Staffing of the manual and noted that credentialing of the clinical staff requires Wesley to document and maintain in an employee file eight items. Auditor tested 7 out of 33 total clinical staff for documentation of the eight compliance requirements. Auditor noted that none of the files tested contained a picture ID or a recent (within past 2 years) performance review. Both of these items are compliance requirements for clinical staff. Effect : WHC is not in compliance with 2 of the 8 credentialing requirements for 7 out of 33 clinical staff. Cause: Lapse in internal controls over HRSA grant requirements. Recommendation: Management should review and monitor clinical staff credentialing requirements to ensure compliance with HCPCM requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with the