Audit 22522

FY End
2022-09-30
Total Expended
$27.04M
Findings
2
Programs
8
Year: 2022 Accepted: 2023-06-28
Auditor: Kpmg

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
20456 2022-001 Material Weakness - ABE
596898 2022-001 Material Weakness - ABE

Programs

ALN Program Spent Major Findings
93.498 Provider Relief Fund $22.18M Yes 0
93.461 Covid-19 Testing for the Uninsured $2.84M Yes 1
32.006 Covid-19 Telehealth Program $867,722 Yes 0
93.279 Drug Abuse and Addiction Research Programs $133,082 - 0
93.464 Acl Assistive Technology $73,075 - 0
93.914 Hiv Emergency Relief Project Grants $62,088 - 0
93.069 Public Health Emergency Preparedness $47,454 - 0
93.253 Poison Center Support and Enhancement Grant $27,476 - 0

Contacts

Name Title Type
EQM8MESHPX43 Paul Pechacek Auditee
8138448272 Todd Webster Auditor
No contacts on file

Notes to SEFA

Title: Relationship to Financial Statements Accounting Policies: General - The accompanying Schedules of Expenditures of Federal Awards and State Financial Assistance (the Schedules) present the activity of all federal and state programs administered by Florida Health Sciences Center, Inc. (the Center). Awards received directly from federal and state agencies, as well as those passed through other governmental agencies, are included on the Schedules. The information in the Schedules 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), and Chapter 10.650, Rules of the Auditor General (Chapter 10.650). Therefore, some amounts presented in this schedule may differ from amounts presented in, or used in the preparation of, the consolidated financial statements. Basis of Accounting Federal and state programs administered by the Center are accounted for within the Centers operating funds. The accompanying Schedules have been prepared on the same basis of accounting as the Centers consolidated financial statements. The Centers consolidated financial statements are prepared in accordance with U.S. generally accepted accounting principles. Transactions are recorded on an accrual accounting basis. Under the accrual method, revenues are recognized when earned and expenses are recognized when a liability is incurred, without regard to receipt or payment of cash. De Minimis Rate Used: Y Rate Explanation: The Center elects the de minimus rate of 5% and 10% for State and Federal awards, respectively, fordetermining indirect cost amounts. Federal awards and state financial assistance revenues are reported in the Centers consolidated financial statements as other revenue.
Title: Contingencies Accounting Policies: General - The accompanying Schedules of Expenditures of Federal Awards and State Financial Assistance (the Schedules) present the activity of all federal and state programs administered by Florida Health Sciences Center, Inc. (the Center). Awards received directly from federal and state agencies, as well as those passed through other governmental agencies, are included on the Schedules. The information in the Schedules 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), and Chapter 10.650, Rules of the Auditor General (Chapter 10.650). Therefore, some amounts presented in this schedule may differ from amounts presented in, or used in the preparation of, the consolidated financial statements. Basis of Accounting Federal and state programs administered by the Center are accounted for within the Centers operating funds. The accompanying Schedules have been prepared on the same basis of accounting as the Centers consolidated financial statements. The Centers consolidated financial statements are prepared in accordance with U.S. generally accepted accounting principles. Transactions are recorded on an accrual accounting basis. Under the accrual method, revenues are recognized when earned and expenses are recognized when a liability is incurred, without regard to receipt or payment of cash. De Minimis Rate Used: Y Rate Explanation: The Center elects the de minimus rate of 5% and 10% for State and Federal awards, respectively, fordetermining indirect cost amounts. Grant monies received and disbursed by the Center are for specific purposes and are subject to review by the grantor agencies. Such audits may result in requests for reimbursement due to disallowed expenditures. Based upon prior experience, the Center does not believe that such disallowances, if any, would have a material effect on the financial position of the Center. Management is not aware of any material questioned or disallowed costs as a result of grant audits in process or completed.
Title: Provider Relief Fund Accounting Policies: General - The accompanying Schedules of Expenditures of Federal Awards and State Financial Assistance (the Schedules) present the activity of all federal and state programs administered by Florida Health Sciences Center, Inc. (the Center). Awards received directly from federal and state agencies, as well as those passed through other governmental agencies, are included on the Schedules. The information in the Schedules 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), and Chapter 10.650, Rules of the Auditor General (Chapter 10.650). Therefore, some amounts presented in this schedule may differ from amounts presented in, or used in the preparation of, the consolidated financial statements. Basis of Accounting Federal and state programs administered by the Center are accounted for within the Centers operating funds. The accompanying Schedules have been prepared on the same basis of accounting as the Centers consolidated financial statements. The Centers consolidated financial statements are prepared in accordance with U.S. generally accepted accounting principles. Transactions are recorded on an accrual accounting basis. Under the accrual method, revenues are recognized when earned and expenses are recognized when a liability is incurred, without regard to receipt or payment of cash. De Minimis Rate Used: Y Rate Explanation: The Center elects the de minimus rate of 5% and 10% for State and Federal awards, respectively, fordetermining indirect cost amounts. As required by the granting agency, the accompanying amounts presented in the schedule of expenditures of federal awards represent lost revenues as reported to the U.S. Department of Health and Human Services for the period July 1, 2020 to December 31, 2020 and the period of January 1, 2021 to June 30, 2021.

Finding Details

Finding 2022-01 ? Activities Allowed or Unallowed, Allowable Costs/Cost Principles and Eligibility Federal Program - AL no. 93.461 COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration for the Uninsured. Pass-through Entities - N/A Federal Agency - U.S. Department of Health and Human Services Federal Award Number and Award Year - No award number, award year 10/1/2021 ? 9/30/2022 Criteria - Activities Allowed or Unallowed, Allowable Costs/Cost Principles and Eligibility? The COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration for the Uninsured program reimburses health care-related expenses attributable to COVID-19 testing for the uninsured and treatment of uninsured individuals with COVID-19. Reimbursement includes COVID-19 testing and testing related items, COVID-19 treatment and COVID-19 vaccine administration fees. The Health Resources and Services Administration (HRSA) FAQ document specifies that COVID-19 must be the primary reason for treatment or for vaccine administration along with the patient being uninsured. Per 2 CFR 200.303, a non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal Award. Condition and Context - KPMG identified 7 patients out of 40 samples (18%) tested in which reimbursement was requested for the patient visit even though the visit was not identified in the patient record as COVID-19 being the primary reason for treatment. KPMG identified 2 patients out of 40 samples (5%) tested in which reimbursement was requested for the patient visit even though the patient had active insurance coverage and thus fully insured for the date of service reimbursed. Possible Cause and Effect - In discussing these unallowable costs and eligibility conditions with the Center, they stated that claims were not appropriately allocated between reimbursable COVID-10 tests and non-reimbursable visits using a non-COVID-19 primary diagnosis code and these claims were not effectively reviewed prior to submission to HRSA. Questioned Costs - Known questioned costs of $204,199. Statistically Valid Sample - The sample was not intended to be, and was not, a statistically valid sample. Repeat of Prior Finding - No Recommendations - We recommend that management review its current processes for entering and reviewing diagnosis codes and eligibility requirements to ensure proper codes are documented for all services in accordance with the federal award programs terms and conditions and therefore the patient is eligible for services. View of Responsible Official - Management agrees with the noted finding. Additionally, management established a work group to review inpatient and outpatient accounts incorrectly billed to HRSA to ensure the amounts were properly refunded. The refund process for overbillings is expected to be completed in the fourth quarter of 2023. Further, the HRSA program has ended and the Center is no longer billing for these services.
Finding 2022-01 ? Activities Allowed or Unallowed, Allowable Costs/Cost Principles and Eligibility Federal Program - AL no. 93.461 COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration for the Uninsured. Pass-through Entities - N/A Federal Agency - U.S. Department of Health and Human Services Federal Award Number and Award Year - No award number, award year 10/1/2021 ? 9/30/2022 Criteria - Activities Allowed or Unallowed, Allowable Costs/Cost Principles and Eligibility? The COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration for the Uninsured program reimburses health care-related expenses attributable to COVID-19 testing for the uninsured and treatment of uninsured individuals with COVID-19. Reimbursement includes COVID-19 testing and testing related items, COVID-19 treatment and COVID-19 vaccine administration fees. The Health Resources and Services Administration (HRSA) FAQ document specifies that COVID-19 must be the primary reason for treatment or for vaccine administration along with the patient being uninsured. Per 2 CFR 200.303, a non-Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal Award. Condition and Context - KPMG identified 7 patients out of 40 samples (18%) tested in which reimbursement was requested for the patient visit even though the visit was not identified in the patient record as COVID-19 being the primary reason for treatment. KPMG identified 2 patients out of 40 samples (5%) tested in which reimbursement was requested for the patient visit even though the patient had active insurance coverage and thus fully insured for the date of service reimbursed. Possible Cause and Effect - In discussing these unallowable costs and eligibility conditions with the Center, they stated that claims were not appropriately allocated between reimbursable COVID-10 tests and non-reimbursable visits using a non-COVID-19 primary diagnosis code and these claims were not effectively reviewed prior to submission to HRSA. Questioned Costs - Known questioned costs of $204,199. Statistically Valid Sample - The sample was not intended to be, and was not, a statistically valid sample. Repeat of Prior Finding - No Recommendations - We recommend that management review its current processes for entering and reviewing diagnosis codes and eligibility requirements to ensure proper codes are documented for all services in accordance with the federal award programs terms and conditions and therefore the patient is eligible for services. View of Responsible Official - Management agrees with the noted finding. Additionally, management established a work group to review inpatient and outpatient accounts incorrectly billed to HRSA to ensure the amounts were properly refunded. The refund process for overbillings is expected to be completed in the fourth quarter of 2023. Further, the HRSA program has ended and the Center is no longer billing for these services.