Audit 16572

FY End
2022-02-28
Total Expended
$2.72M
Findings
12
Programs
5
Year: 2022 Accepted: 2023-05-07
Auditor: Cohnreznick LLP

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
12275 2022-003 Material Weakness Yes N
12276 2022-004 Material Weakness - L
12277 2022-003 Material Weakness Yes N
12278 2022-004 Material Weakness - L
12279 2022-003 Material Weakness Yes N
12280 2022-004 Material Weakness - L
588717 2022-003 Material Weakness Yes N
588718 2022-004 Material Weakness - L
588719 2022-003 Material Weakness Yes N
588720 2022-004 Material Weakness - L
588721 2022-003 Material Weakness Yes N
588722 2022-004 Material Weakness - L

Contacts

Name Title Type
U5AMQ7MF83B1 Steven Mayers Auditee
3407753700 Steven D Schwartz Auditor
No contacts on file

Notes to SEFA

Title: Note 1 - Basis of presentation Accounting Policies: Note 2 - Summary of significant accounting policiesExpenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The Center has elected not to use the 10-percent de minimis indirect cost rate as allowed under the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. The accompanying schedule of expenditures of federal awards (the "Schedule") includes the federal award activity of St. Thomas East End Medical Center Corporation (the "Center") under programs of the federal government for the year ended February 28, 2022. The information in this Schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (the "Uniform Guidance"). Because the Schedule presents only a selected portion of the operations of the Center, it is not intended to and does not represent the financial position, changes in net assets, or cash flow of the Center.
Title: Note 3 - COVID-19 - Provider Relief Fund and American Rescue Plan (ARP) Rur Accounting Policies: Note 2 - Summary of significant accounting policiesExpenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The Center has elected not to use the 10-percent de minimis indirect cost rate as allowed under the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. For the DHHS awards related to the Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF) program, DHHS has indicated the amounts on the Schedule be reported corresponding to reporting requirements of the HRSA PRF Reporting Portal. Payments from DHHS for PRF are assigned to "Payment Received Periods" (each, a Period) based upon the date each payment from the PRF was received. Each Period has a specified Period of Availability and timing of reporting requirements. Entities report into the HRSA PRF Reporting Portal after each Period's deadline to use the funds (i.e., after the end of the Period of Availability).The Schedule includes $185,737 received from DHHS between April 10, 2020 and May 6, 2020. In accordance with guidance from DHHS, this amount represents $185,737 for Period 1. Such amounts were recognized as DHHS grant revenue in the consolidated financial statements in the year ended February 28, 2021.
Title: Note 4 - COVID-19 - HRSA COVID-19 Claims Reimbursement for the Uninsured Pr Accounting Policies: Note 2 - Summary of significant accounting policiesExpenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The Center has elected not to use the 10-percent de minimis indirect cost rate as allowed under the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. For the DHHS award related to the HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund program (the Uninsured/CAF Program), the amount on the Schedule relates to the amount of revenue recognized in the consolidated financial statements during the year ended February 28, 2022.

Finding Details

Item 2022-003 - Special Tests and Provisions U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) 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 Center should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Statement of Condition While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to certain patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Questioned Costs None Context While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to two out of the sixty patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Cause The condition can be attributed to human error and the lack of internal controls to review and ensure that the proper sliding fee documentation is being maintained and applied. Effect The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended February 28, 2022. In addition, the Center may not have properly calculated the sliding fee or discount given to the patients and the discount given, if any, may not have been based on the patient's ability to pay. Identification as a Repeat Finding Condition is a repeat finding - see 2021-003. Recommendation We recommend that proper training be given to employees at registration to ensure that the sliding fee discounts be monitored and reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. In addition, management should conduct internal audits to ensure the sliding fee scale is calculated properly. Views of Responsible Official The Center concurs with this finding and will ensure that controls are established to ensure proper training and review of the sliding fee discounts.
Item 2022-004 - Reporting U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) Criteria In accordance with the Uniform Guidance, annual audit reports of recipients of federal funds are required to be submitted to the Federal Audit Clearing House, within the earlier of 30 days after the receipt of the audit report or 9 months after the end of the audit period. Statement of Condition The Center did not submit their annual audit in accordance with the Uniform Guidance on a timely basis. Questioned Costs None Context The Center did not submit their annual audit on a timely basis. Cause Due to turnover in the financial leadership position, the Center's finance department was not able to perform detailed review of accounts and adjust books accordingly, which delayed the filing of the annual audit report. Effect The Center did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification as a Repeat Finding Condition is not a repeat finding. Recommendation We recommend that the Organization establish controls to ensure all accounting records are analyzed and proper support is available in order to ensure that the financial statement audit is submitted on a timely basis to the federal government. Views of Responsible Official Management and the Board of Directors agree. The reporting for the fiscal year 2022 audit was deficient due to turnover in the financial leadership position and the lack of appropriate resources in the finance department. The Organization is onboarding new leadership in 2023 and the Organization expects to enact the recommendations for the fiscal year 2023 audit.
Item 2022-003 - Special Tests and Provisions U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) 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 Center should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Statement of Condition While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to certain patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Questioned Costs None Context While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to two out of the sixty patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Cause The condition can be attributed to human error and the lack of internal controls to review and ensure that the proper sliding fee documentation is being maintained and applied. Effect The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended February 28, 2022. In addition, the Center may not have properly calculated the sliding fee or discount given to the patients and the discount given, if any, may not have been based on the patient's ability to pay. Identification as a Repeat Finding Condition is a repeat finding - see 2021-003. Recommendation We recommend that proper training be given to employees at registration to ensure that the sliding fee discounts be monitored and reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. In addition, management should conduct internal audits to ensure the sliding fee scale is calculated properly. Views of Responsible Official The Center concurs with this finding and will ensure that controls are established to ensure proper training and review of the sliding fee discounts.
Item 2022-004 - Reporting U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) Criteria In accordance with the Uniform Guidance, annual audit reports of recipients of federal funds are required to be submitted to the Federal Audit Clearing House, within the earlier of 30 days after the receipt of the audit report or 9 months after the end of the audit period. Statement of Condition The Center did not submit their annual audit in accordance with the Uniform Guidance on a timely basis. Questioned Costs None Context The Center did not submit their annual audit on a timely basis. Cause Due to turnover in the financial leadership position, the Center's finance department was not able to perform detailed review of accounts and adjust books accordingly, which delayed the filing of the annual audit report. Effect The Center did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification as a Repeat Finding Condition is not a repeat finding. Recommendation We recommend that the Organization establish controls to ensure all accounting records are analyzed and proper support is available in order to ensure that the financial statement audit is submitted on a timely basis to the federal government. Views of Responsible Official Management and the Board of Directors agree. The reporting for the fiscal year 2022 audit was deficient due to turnover in the financial leadership position and the lack of appropriate resources in the finance department. The Organization is onboarding new leadership in 2023 and the Organization expects to enact the recommendations for the fiscal year 2023 audit.
Item 2022-003 - Special Tests and Provisions U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) 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 Center should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Statement of Condition While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to certain patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Questioned Costs None Context While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to two out of the sixty patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Cause The condition can be attributed to human error and the lack of internal controls to review and ensure that the proper sliding fee documentation is being maintained and applied. Effect The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended February 28, 2022. In addition, the Center may not have properly calculated the sliding fee or discount given to the patients and the discount given, if any, may not have been based on the patient's ability to pay. Identification as a Repeat Finding Condition is a repeat finding - see 2021-003. Recommendation We recommend that proper training be given to employees at registration to ensure that the sliding fee discounts be monitored and reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. In addition, management should conduct internal audits to ensure the sliding fee scale is calculated properly. Views of Responsible Official The Center concurs with this finding and will ensure that controls are established to ensure proper training and review of the sliding fee discounts.
Item 2022-004 - Reporting U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) Criteria In accordance with the Uniform Guidance, annual audit reports of recipients of federal funds are required to be submitted to the Federal Audit Clearing House, within the earlier of 30 days after the receipt of the audit report or 9 months after the end of the audit period. Statement of Condition The Center did not submit their annual audit in accordance with the Uniform Guidance on a timely basis. Questioned Costs None Context The Center did not submit their annual audit on a timely basis. Cause Due to turnover in the financial leadership position, the Center's finance department was not able to perform detailed review of accounts and adjust books accordingly, which delayed the filing of the annual audit report. Effect The Center did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification as a Repeat Finding Condition is not a repeat finding. Recommendation We recommend that the Organization establish controls to ensure all accounting records are analyzed and proper support is available in order to ensure that the financial statement audit is submitted on a timely basis to the federal government. Views of Responsible Official Management and the Board of Directors agree. The reporting for the fiscal year 2022 audit was deficient due to turnover in the financial leadership position and the lack of appropriate resources in the finance department. The Organization is onboarding new leadership in 2023 and the Organization expects to enact the recommendations for the fiscal year 2023 audit.
Item 2022-003 - Special Tests and Provisions U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) 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 Center should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Statement of Condition While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to certain patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Questioned Costs None Context While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to two out of the sixty patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Cause The condition can be attributed to human error and the lack of internal controls to review and ensure that the proper sliding fee documentation is being maintained and applied. Effect The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended February 28, 2022. In addition, the Center may not have properly calculated the sliding fee or discount given to the patients and the discount given, if any, may not have been based on the patient's ability to pay. Identification as a Repeat Finding Condition is a repeat finding - see 2021-003. Recommendation We recommend that proper training be given to employees at registration to ensure that the sliding fee discounts be monitored and reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. In addition, management should conduct internal audits to ensure the sliding fee scale is calculated properly. Views of Responsible Official The Center concurs with this finding and will ensure that controls are established to ensure proper training and review of the sliding fee discounts.
Item 2022-004 - Reporting U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) Criteria In accordance with the Uniform Guidance, annual audit reports of recipients of federal funds are required to be submitted to the Federal Audit Clearing House, within the earlier of 30 days after the receipt of the audit report or 9 months after the end of the audit period. Statement of Condition The Center did not submit their annual audit in accordance with the Uniform Guidance on a timely basis. Questioned Costs None Context The Center did not submit their annual audit on a timely basis. Cause Due to turnover in the financial leadership position, the Center's finance department was not able to perform detailed review of accounts and adjust books accordingly, which delayed the filing of the annual audit report. Effect The Center did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification as a Repeat Finding Condition is not a repeat finding. Recommendation We recommend that the Organization establish controls to ensure all accounting records are analyzed and proper support is available in order to ensure that the financial statement audit is submitted on a timely basis to the federal government. Views of Responsible Official Management and the Board of Directors agree. The reporting for the fiscal year 2022 audit was deficient due to turnover in the financial leadership position and the lack of appropriate resources in the finance department. The Organization is onboarding new leadership in 2023 and the Organization expects to enact the recommendations for the fiscal year 2023 audit.
Item 2022-003 - Special Tests and Provisions U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) 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 Center should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Statement of Condition While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to certain patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Questioned Costs None Context While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to two out of the sixty patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Cause The condition can be attributed to human error and the lack of internal controls to review and ensure that the proper sliding fee documentation is being maintained and applied. Effect The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended February 28, 2022. In addition, the Center may not have properly calculated the sliding fee or discount given to the patients and the discount given, if any, may not have been based on the patient's ability to pay. Identification as a Repeat Finding Condition is a repeat finding - see 2021-003. Recommendation We recommend that proper training be given to employees at registration to ensure that the sliding fee discounts be monitored and reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. In addition, management should conduct internal audits to ensure the sliding fee scale is calculated properly. Views of Responsible Official The Center concurs with this finding and will ensure that controls are established to ensure proper training and review of the sliding fee discounts.
Item 2022-004 - Reporting U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) Criteria In accordance with the Uniform Guidance, annual audit reports of recipients of federal funds are required to be submitted to the Federal Audit Clearing House, within the earlier of 30 days after the receipt of the audit report or 9 months after the end of the audit period. Statement of Condition The Center did not submit their annual audit in accordance with the Uniform Guidance on a timely basis. Questioned Costs None Context The Center did not submit their annual audit on a timely basis. Cause Due to turnover in the financial leadership position, the Center's finance department was not able to perform detailed review of accounts and adjust books accordingly, which delayed the filing of the annual audit report. Effect The Center did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification as a Repeat Finding Condition is not a repeat finding. Recommendation We recommend that the Organization establish controls to ensure all accounting records are analyzed and proper support is available in order to ensure that the financial statement audit is submitted on a timely basis to the federal government. Views of Responsible Official Management and the Board of Directors agree. The reporting for the fiscal year 2022 audit was deficient due to turnover in the financial leadership position and the lack of appropriate resources in the finance department. The Organization is onboarding new leadership in 2023 and the Organization expects to enact the recommendations for the fiscal year 2023 audit.
Item 2022-003 - Special Tests and Provisions U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) 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 Center should be implementing and monitoring procedures to properly determine, calculate and review sliding fee discounts issued to patients in accordance with the Center's sliding fee scale. Statement of Condition While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to certain patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Questioned Costs None Context While performing our audit, we noted that the Center did not properly determine the sliding fee discount category given to two out of the sixty patients selected for testing based on the sliding fee scale in effect for the year ended February 28, 2022. Cause The condition can be attributed to human error and the lack of internal controls to review and ensure that the proper sliding fee documentation is being maintained and applied. Effect The Center did not comply with the determination of sliding fee discounts based on the federal poverty guidelines in effect for the year ended February 28, 2022. In addition, the Center may not have properly calculated the sliding fee or discount given to the patients and the discount given, if any, may not have been based on the patient's ability to pay. Identification as a Repeat Finding Condition is a repeat finding - see 2021-003. Recommendation We recommend that proper training be given to employees at registration to ensure that the sliding fee discounts be monitored and reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. In addition, management should conduct internal audits to ensure the sliding fee scale is calculated properly. Views of Responsible Official The Center concurs with this finding and will ensure that controls are established to ensure proper training and review of the sliding fee discounts.
Item 2022-004 - Reporting U.S. Department of Health and Human Services, COVID-19 Health Center Program Cluster (Assistance Listing Number 93.224/93.527) Criteria In accordance with the Uniform Guidance, annual audit reports of recipients of federal funds are required to be submitted to the Federal Audit Clearing House, within the earlier of 30 days after the receipt of the audit report or 9 months after the end of the audit period. Statement of Condition The Center did not submit their annual audit in accordance with the Uniform Guidance on a timely basis. Questioned Costs None Context The Center did not submit their annual audit on a timely basis. Cause Due to turnover in the financial leadership position, the Center's finance department was not able to perform detailed review of accounts and adjust books accordingly, which delayed the filing of the annual audit report. Effect The Center did not comply with the appropriate rules and regulations as per the Uniform Guidance. Identification as a Repeat Finding Condition is not a repeat finding. Recommendation We recommend that the Organization establish controls to ensure all accounting records are analyzed and proper support is available in order to ensure that the financial statement audit is submitted on a timely basis to the federal government. Views of Responsible Official Management and the Board of Directors agree. The reporting for the fiscal year 2022 audit was deficient due to turnover in the financial leadership position and the lack of appropriate resources in the finance department. The Organization is onboarding new leadership in 2023 and the Organization expects to enact the recommendations for the fiscal year 2023 audit.