FAC Explorer

Audit 25996

FY End
2022-12-31
Total Expended
$3.44M
Findings
4
Programs
6
Organization: Flushing Hospital Medical Center (NY)
Year: 2022 Accepted: 2023-08-28
Auditor: Pricewaterhousecoopers

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
21588 2022-001 - - L
21589 2022-002 Significant Deficiency - J
598030 2022-001 - - L
598031 2022-002 Significant Deficiency - J

Programs

ALN Program Spent Major Findings
93.829 Certified Community Behavioral Health- Clinic Demonstration Grant $1.66M Yes 2
93.498 Covid-19 Provider Relief Fund and American Rescue Plan (arp) Rural Distribution $1.15M Yes 0
93.243 Medication-Assisted Treatment Prescription Drug and Opioid Addiction $430,298 - 0
93.696 Certified Community Behavioral Health Clinic Expansion Grants $141,822 - 0
93.461 Covid-19 Hrsa Claims Reimbursement for the Uninsured Program $31,681 - 0
93.889 Public Health Emergency Preparedness $25,750 - 0

Contacts

Name Title Type
J36RZM1LEN63 Manzar Sassani Auditee
7182066291 Kate Corgel Auditor
No contacts on file

Notes to SEFA

Title: COVID-19 HRSA Claims Reimbursement for the Uninsured Program Accounting Policies: The accompanying schedule of expenditures of federal awards (the Schedule) presents the federal grant activity of Flushing Hospital Medical Center and its subsidiary (Flushing). The information in the 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 (Uniform Guidance). The purpose of the Schedule is to present a summary of those activities of Flushing for the year ended December 31, 2022 which have been financed by the federal government. For purposes of the Schedule, federal awards include any assistance provided by a federal agency directly or indirectly in the form of loans or grants, contracts, cooperative agreements, loans and loan guarantees, and other noncash assistance. Where available, passthrough entity identifying numbers are included in the Schedule. Because the Schedule presents only a selected portion of the activities of Flushing, it is not intended to and does not present either the financial position or the revenues, expenditures, and other changes in net deficit of Flushing. Therefore, some amounts presented in this schedule may differ from amounts presented in, or used in, the preparation of Flushings consolidated financial statements.Expenditures for direct costs within the Schedule are recognized using the accrual method of accounting and in accordance with The Department of Health and Human Services, U.S. Office of the Assistant Secretary Comptroller (OASC) OASC3, A Guide for Hospitals. Under those cost principles, certain types of expenditures are not allowable or are limited as to reimbursement. Flushing applies the indirect cost rate approved by the granting agency at the time of the award rather than the 10% de minimis indirect cost rate as described in Section 200.414 of the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: Flushing applies the indirect cost rate approved by the granting agency at the time of the award rather than the 10% de minimis indirect cost rate as described in Section 200.414 of the Uniform Guidance. Flushing conducted COVID-19 testing and/or provided treatment for uninsured individuals with a COVID-19 primary diagnosis and requested claims reimbursement under the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration's ("HRSA") COVID-19 Claims Reimbursement for the Uninsured Program (Assistance Listing Number 93.461) through the end of the award period in 2022. Claims for testing and treatment were accepted through March 22, 2022 and claims for vaccine administration were accepted through April 5, 2022.The amount recorded on the Schedule reflects reimbursement on eligible claims with through the end of the award period.
Title: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distr Accounting Policies: The accompanying schedule of expenditures of federal awards (the Schedule) presents the federal grant activity of Flushing Hospital Medical Center and its subsidiary (Flushing). The information in the 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 (Uniform Guidance). The purpose of the Schedule is to present a summary of those activities of Flushing for the year ended December 31, 2022 which have been financed by the federal government. For purposes of the Schedule, federal awards include any assistance provided by a federal agency directly or indirectly in the form of loans or grants, contracts, cooperative agreements, loans and loan guarantees, and other noncash assistance. Where available, passthrough entity identifying numbers are included in the Schedule. Because the Schedule presents only a selected portion of the activities of Flushing, it is not intended to and does not present either the financial position or the revenues, expenditures, and other changes in net deficit of Flushing. Therefore, some amounts presented in this schedule may differ from amounts presented in, or used in, the preparation of Flushings consolidated financial statements.Expenditures for direct costs within the Schedule are recognized using the accrual method of accounting and in accordance with The Department of Health and Human Services, U.S. Office of the Assistant Secretary Comptroller (OASC) OASC3, A Guide for Hospitals. Under those cost principles, certain types of expenditures are not allowable or are limited as to reimbursement. Flushing applies the indirect cost rate approved by the granting agency at the time of the award rather than the 10% de minimis indirect cost rate as described in Section 200.414 of the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: Flushing applies the indirect cost rate approved by the granting agency at the time of the award rather than the 10% de minimis indirect cost rate as described in Section 200.414 of the Uniform Guidance. During the years ended December 31, 2021 and 2020, Flushing received Provider Relief Funds (PRF) under Assistance Listing Number 93.498 from HHS, as further described in Note 13 to the consolidated financial statements. Pursuant to the guidance provided by HHS, the Schedule includes all Period 4 funds received between July 1, 2021 and December 31, 2021 and expended by December 31, 2022 as reported to HRSA via the PRF Reporting Portal.Flushing did not receive any Period 3 funds between January 1, 2021 and June 30, 2021.

Finding Details

Finding 2022-001
2022-001: Untimely and Incomplete Submission of Federal Financial Report Federal Agency: Department of Health and Human Services (?HHS?) Program: Certified Community Behavioral Health Clinic Demonstration Grant Assistance Listing Number: 93.829 Criteria In accordance with the notice of award (?NoA?), the annual Federal Financial Report (FFR) is required to be submitted by July 31, 2022 and is required to include program income earned by Flushing during the period covered by the FFR. Condition The annual FFR was due July 31, 2022. Flushing initially submitted the FFR to HHS through the Payment Management System on August 31, 2022. The report required revisions and was ultimately accepted on October 25, 2022. Additionally, the FFR ultimately submitted and accepted on October 25, 2022 did not include the required reporting of program income. Questioned Costs None Cause A lack of management oversight existed over the annual FFR submission requirements. Effect The untimely submission of the annual FFR and the omission of the required program income information within the FFR that was ultimately submitted causes Flushing to be out of compliance with specific grant reporting requirements. Recommendation We recommend Flushing formalize a control around the completion and review of the FFR to ensure the annual FFR is completed and submitted to HHS in a timely manner. Additionally, we recommend that management enhance its existing review process of the annual FFR to include a verification that all required information that is relevant and applicable to Flushing?s award is reflected in the FFR prior to submission to HHS. Management?s Views and Corrective Action Plan Management?s Views and Corrective Action Plan is included at the end of this report.
Finding 2022-002
2022-02: Significant Deficiency ? Program income compliance and controls Federal Agency: Department of Health and Human Services Program: Certified Community Behavioral Health Clinic Demonstration Grant Assistance Listing Number: 93.829 Criteria In accordance with the NoA, ?Recipients will add program income to funds committed to the project to further eligible project objectives.? Condition Flushing did not have a formal control in place to identify, monitor and report program income collected from providing mental health counseling services to patients under the Certified Community Behavioral Health Clinic Demonstration Grant (?Demonstration Grant?). Questioned Costs During the year ended December 31, 2022, Flushing collected program income of $58,039 from billings related to mental health counseling services provided under the Demonstration Grant. Management did not use program income to further eligible project objectives of the Demonstration Grant. However, the Demonstration Grant?s budget included $165,114 of allowable indirect costs over the award period (May 1, 2020 through December 3, 2022), for which Flushing did not request reimbursement. Cause The Demonstration Grant is Flushing?s only grant that includes a program income compliance requirement. Management?s inexperience with this compliance requirement led to the failure to identify the program income compliance requirement. As a result, Flushing did not design and implement controls over program income. Effect Management did not have a control in place to ensure compliance with the program income requirement of the Demonstration Grant and did not add the program income funds collected during the year ended December 31, 2022 to funds committed to further eligible project objectives, as required by the NoA. Recommendation We recommend Flushing design and implement formal controls around the program income compliance requirement for the Demonstration Grant. Specifically, we recommend management?s controls include performing the following activities on an ongoing basis: (1) Review patient-level program income reports for completeness and accuracy to ensure only patients that received counseling services under the Demonstration Grant are included; (2) Maintain documentation supporting how the program income was used to further eligible project objectives; and (3) Ensure review of the information in steps (1) and (2) prior to requesting reimbursement under the Demonstration Grant. We also recommend that Flushing contact HHS to inform them of the noncompliance with the program income requirement during the year ended December 31, 2022. Management?s Views and Corrective Action Plan Management?s Views and Corrective Action Plan is included at the end of this report.
Finding 2022-001
2022-001: Untimely and Incomplete Submission of Federal Financial Report Federal Agency: Department of Health and Human Services (?HHS?) Program: Certified Community Behavioral Health Clinic Demonstration Grant Assistance Listing Number: 93.829 Criteria In accordance with the notice of award (?NoA?), the annual Federal Financial Report (FFR) is required to be submitted by July 31, 2022 and is required to include program income earned by Flushing during the period covered by the FFR. Condition The annual FFR was due July 31, 2022. Flushing initially submitted the FFR to HHS through the Payment Management System on August 31, 2022. The report required revisions and was ultimately accepted on October 25, 2022. Additionally, the FFR ultimately submitted and accepted on October 25, 2022 did not include the required reporting of program income. Questioned Costs None Cause A lack of management oversight existed over the annual FFR submission requirements. Effect The untimely submission of the annual FFR and the omission of the required program income information within the FFR that was ultimately submitted causes Flushing to be out of compliance with specific grant reporting requirements. Recommendation We recommend Flushing formalize a control around the completion and review of the FFR to ensure the annual FFR is completed and submitted to HHS in a timely manner. Additionally, we recommend that management enhance its existing review process of the annual FFR to include a verification that all required information that is relevant and applicable to Flushing?s award is reflected in the FFR prior to submission to HHS. Management?s Views and Corrective Action Plan Management?s Views and Corrective Action Plan is included at the end of this report.
Finding 2022-002
2022-02: Significant Deficiency ? Program income compliance and controls Federal Agency: Department of Health and Human Services Program: Certified Community Behavioral Health Clinic Demonstration Grant Assistance Listing Number: 93.829 Criteria In accordance with the NoA, ?Recipients will add program income to funds committed to the project to further eligible project objectives.? Condition Flushing did not have a formal control in place to identify, monitor and report program income collected from providing mental health counseling services to patients under the Certified Community Behavioral Health Clinic Demonstration Grant (?Demonstration Grant?). Questioned Costs During the year ended December 31, 2022, Flushing collected program income of $58,039 from billings related to mental health counseling services provided under the Demonstration Grant. Management did not use program income to further eligible project objectives of the Demonstration Grant. However, the Demonstration Grant?s budget included $165,114 of allowable indirect costs over the award period (May 1, 2020 through December 3, 2022), for which Flushing did not request reimbursement. Cause The Demonstration Grant is Flushing?s only grant that includes a program income compliance requirement. Management?s inexperience with this compliance requirement led to the failure to identify the program income compliance requirement. As a result, Flushing did not design and implement controls over program income. Effect Management did not have a control in place to ensure compliance with the program income requirement of the Demonstration Grant and did not add the program income funds collected during the year ended December 31, 2022 to funds committed to further eligible project objectives, as required by the NoA. Recommendation We recommend Flushing design and implement formal controls around the program income compliance requirement for the Demonstration Grant. Specifically, we recommend management?s controls include performing the following activities on an ongoing basis: (1) Review patient-level program income reports for completeness and accuracy to ensure only patients that received counseling services under the Demonstration Grant are included; (2) Maintain documentation supporting how the program income was used to further eligible project objectives; and (3) Ensure review of the information in steps (1) and (2) prior to requesting reimbursement under the Demonstration Grant. We also recommend that Flushing contact HHS to inform them of the noncompliance with the program income requirement during the year ended December 31, 2022. Management?s Views and Corrective Action Plan Management?s Views and Corrective Action Plan is included at the end of this report.