Audit 315421

FY End
2023-06-30
Total Expended
$11.84M
Findings
18
Programs
14
Year: 2023 Accepted: 2024-07-18
Auditor: Moss Adams LLP

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
478771 2023-002 Significant Deficiency - B
478772 2023-003 Significant Deficiency - L
478773 2023-004 Significant Deficiency - G
478774 2023-005 Significant Deficiency - L
478775 2023-006 Significant Deficiency - BH
478776 2023-007 Significant Deficiency Yes BH
478777 2023-008 Significant Deficiency Yes B
478778 2023-009 Significant Deficiency Yes CH
478779 2023-010 Significant Deficiency Yes L
1055213 2023-002 Significant Deficiency - B
1055214 2023-003 Significant Deficiency - L
1055215 2023-004 Significant Deficiency - G
1055216 2023-005 Significant Deficiency - L
1055217 2023-006 Significant Deficiency - BH
1055218 2023-007 Significant Deficiency Yes BH
1055219 2023-008 Significant Deficiency Yes B
1055220 2023-009 Significant Deficiency Yes CH
1055221 2023-010 Significant Deficiency Yes L

Contacts

Name Title Type
J7HXQG5NE873 Ann Metzger Auditee
5103467563 Brian Conner Auditor
No contacts on file

Notes to SEFA

Title: NOTE 1 – ORGANIZATION Accounting Policies: The information in the accompanying Schedule is presented in accordance with the requirements of the Uniform Guidance. Because the Schedule presents only a select portion of the operations of the Health System, it is not intended to and does not present the financial position, changes in net position, or cash flows of the Health System. Federal expenditures agree or can be reconciled with the amounts reported in the Health System's basic financial statements. De Minimis Rate Used: N Rate Explanation: The Health System has not elected to use the 10 percent de minimus indirect cost rate allowed under the Uniform Guidance. The Health System negotiates indirect cost rates separately for each contract. Alameda Health System (the Health System) is a Public Hospital Authority created originally under the name of Alameda County Medical Center (the Medical Center) on July 1, 1998, pursuant to California Health and Safety Code Section 101850. The governance, management, administration, and control of healthcare facilities were transferred from the County of Alameda (the County) to the Medical Center in 1998. The Medical Center started doing business as the Health System on January 1, 2013. The Health System is reflected in the County’s annual comprehensive financial report as a discretely presented component unit. The Health System provides a continuum of acute and long-term care to residents of the County. In addition to offering general acute care, skilled nursing, and rehabilitative care, the Health System provides an adult day health center, and a trauma center. The Health System is currently staffed for 289 acute, 69 acute psychiatric, and 325 sub-acute, skilled nursing and rehab beds. The Health System is governed by a nine-member board of trustees (Trustees), eight members of which have been appointed by a majority vote of the Board of Supervisors of the County. Trustees are appointed for three-year terms and can be reappointed for up to three consecutive complete terms. The remaining position on the Board of Trustees is filled by a representative of the medical staff of the Health System, which is also appointed by the Board of Supervisors
Title: NOTE 2 – BASIS OF ACCOUNTING Accounting Policies: The information in the accompanying Schedule is presented in accordance with the requirements of the Uniform Guidance. Because the Schedule presents only a select portion of the operations of the Health System, it is not intended to and does not present the financial position, changes in net position, or cash flows of the Health System. Federal expenditures agree or can be reconciled with the amounts reported in the Health System's basic financial statements. De Minimis Rate Used: N Rate Explanation: The Health System has not elected to use the 10 percent de minimus indirect cost rate allowed under the Uniform Guidance. The Health System negotiates indirect cost rates separately for each contract. The schedule of expenditures of federal awards (the Schedule) includes the federal grant activity of the Health System. All federal awards received directly from federal agencies as well as federal awards passed through other entities are included in this Schedule except for assistance related to Medical Assistance (Medi-Cal) and Medicare Hospital Insurance (Medicare) described in Note 4. The Schedule is presented using the accrual basis of accounting, which is described in Note 2 to the Health System’s basic financial statements. Expenditures reported include any property or equipment acquisitions incurred under the federal program. Under the accrual basis of accounting, expenditures are recognized when incurred, regardless of timing of cash flows. Such expenditures are recognized following the cost principles contained in the Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements, for Federal Awards (Uniform Guidance), wherein certain types of expenditures are not allowable or are limited as to reimbursement. In accordance with guidance from the U.S. Department of Health and Human Services (HHS), the Health System included the Reporting Period 4 expenditures for Provider Relief Fund and American Rescue Plan Distribution Federal Assistance Listing No. (FALN) 93.498 of $3,501,621, respectively, in the Schedule for the year ended June 30, 2023, to align with HHS reporting guidelines. In accordance with U.S. GAAP, the total amount of $3,501,621 of Provider Relief Fund assistance received by the Health System was recognized as revenue during the year ended June 30, 2022, and is included in beginning net assets as of and for the year ended June 30, 2023.
Title: Note 3 – Relationship to the Basic Financial Statements Accounting Policies: The information in the accompanying Schedule is presented in accordance with the requirements of the Uniform Guidance. Because the Schedule presents only a select portion of the operations of the Health System, it is not intended to and does not present the financial position, changes in net position, or cash flows of the Health System. Federal expenditures agree or can be reconciled with the amounts reported in the Health System's basic financial statements. De Minimis Rate Used: N Rate Explanation: The Health System has not elected to use the 10 percent de minimus indirect cost rate allowed under the Uniform Guidance. The Health System negotiates indirect cost rates separately for each contract. The information in the accompanying Schedule is presented in accordance with the requirements of the Uniform Guidance. Because the Schedule presents only a select portion of the operations of the Health System, it is not intended to and does not present the financial position, changes in net position, or cash flows of the Health System. Federal expenditures agree or can be reconciled with the amounts reported in the Health System’s basic financial statements.
Title: NOTE 4 – MEDI-CAL AND MEDICARE PROGRAMS Accounting Policies: The information in the accompanying Schedule is presented in accordance with the requirements of the Uniform Guidance. Because the Schedule presents only a select portion of the operations of the Health System, it is not intended to and does not present the financial position, changes in net position, or cash flows of the Health System. Federal expenditures agree or can be reconciled with the amounts reported in the Health System's basic financial statements. De Minimis Rate Used: N Rate Explanation: The Health System has not elected to use the 10 percent de minimus indirect cost rate allowed under the Uniform Guidance. The Health System negotiates indirect cost rates separately for each contract. Direct Medi-Cal and Medicare expenditures are excluded from the Schedule. These expenses represent fees for services and are not included in the Schedule or in determining major programs. The Health System provides Medi-Cal and Medicare services through its facilities. The Health System participates in the California Medi-Cal Administrative Activities (MAA) program, which offers reimbursement under the federal Medical Assistance Program (FALN 93.778) for a portion of the costs related to specific, approved activities that are necessary for the proper and efficient administration of the Medi-Cal program.
Title: NOTE 5 – SUBRECIPIENTS Accounting Policies: The information in the accompanying Schedule is presented in accordance with the requirements of the Uniform Guidance. Because the Schedule presents only a select portion of the operations of the Health System, it is not intended to and does not present the financial position, changes in net position, or cash flows of the Health System. Federal expenditures agree or can be reconciled with the amounts reported in the Health System's basic financial statements. De Minimis Rate Used: N Rate Explanation: The Health System has not elected to use the 10 percent de minimus indirect cost rate allowed under the Uniform Guidance. The Health System negotiates indirect cost rates separately for each contract. The Health System did not provide federal awards to subrecipients during the year ended June 30, 2023.
Title: NOTE 6 - INDIRECT COSTS Accounting Policies: The information in the accompanying Schedule is presented in accordance with the requirements of the Uniform Guidance. Because the Schedule presents only a select portion of the operations of the Health System, it is not intended to and does not present the financial position, changes in net position, or cash flows of the Health System. Federal expenditures agree or can be reconciled with the amounts reported in the Health System's basic financial statements. De Minimis Rate Used: N Rate Explanation: The Health System has not elected to use the 10 percent de minimus indirect cost rate allowed under the Uniform Guidance. The Health System negotiates indirect cost rates separately for each contract. The Health System has not elected to use the 10 percent de minimus indirect cost rate allowed under the Uniform Guidance. The Health System negotiates indirect cost rates separately for each contract.
Title: Note 7 – Crime Victim Assistance Program Accounting Policies: The information in the accompanying Schedule is presented in accordance with the requirements of the Uniform Guidance. Because the Schedule presents only a select portion of the operations of the Health System, it is not intended to and does not present the financial position, changes in net position, or cash flows of the Health System. Federal expenditures agree or can be reconciled with the amounts reported in the Health System's basic financial statements. De Minimis Rate Used: N Rate Explanation: The Health System has not elected to use the 10 percent de minimus indirect cost rate allowed under the Uniform Guidance. The Health System negotiates indirect cost rates separately for each contract. The Health System has the following programs presented in the Schedule under Federal Assistance Listing No.16.575. Program Description: 1) Rape Crisis Program, Contract Number - RC21 37 1146, and Federal Expenditures of $126,492; 2) Rape Crisis Program, Contract Number - RC22 38 1146, and Federal Expenditures of $306,847; 3) Sexual Assault Response Team Program, Contract Number - XS21 04 1146, and Federal Expenditures of $51,719; 4) Sexual Assault Response Team Program, Contract Number - XS22 05 1146, and Federal Expenditures of $6,032; 5) Domestic Violence Housing First Program, Contract Number - XD21 03 1146, and Federal Expenditures of $61,731; 6) Specialized Emergency Housing Program, Contract Number - KE21 04 1146, and Federal Expenditures of $81,047; 7) Specialized Emergency Housing Program, Contract Number - KE22 01 1146, and Federal Expenditures of $229,382; and total Federal Expenditures of $863,250.

Finding Details

Finding Number 2023-002: Timesheet vs. Time Study Hours (Significant Deficiency over Internal Control and Instance of Noncompliance – Allowable Costs/Cost Principles) FALN Number 93.778 Alameda Health Care Services Agency - Medical Assistance Program (Medi-Cal Administrative Activities), Award Number MAA MOU 2022-2023, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.403(h) stated that a non-federal entity may charge only allowable costs incurred during the approved budget period of a federal award’s period of performance. Condition/Context: As a result of our audit procedures, we noted 1 of 40 timesheets tested in which the hours on the employee’s timesheet did not agree to the hours reported on the time study. We identified 2.5 hours of steward leave being reported on the timesheet but not the time study. Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure hours reported on the timesheet agree to the hours on the time study, which could lead to inaccurate hours being reported and disbursed to employees. Questioned Cost: None Recommendation: We recommend management review policies and procedures to ensure the hours reported on the timesheet agree to the hours on the time study. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that costs incurred are appropriately charged based on the contracts’ performance periods.
Finding Number 2023-003: Reporting (Significant Deficiency over Internal Control and Instances of Noncompliance – Reporting) FALN Number 93.224 Health Center Program (Community Health Centers, Migrant Health Centers, Health care for the Homeless, and Public Housing Primary Care), Award Number MAA MOU 2022-2023, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.303(a) stated that the 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 terms and conditions of the federal award. Condition/Context: As a result of our audit procedures over the yearly reports, we noted the Uniform Data System (UDS) Clinical Measures Report and Financial Report did not have evidence of management’s review prior to report submission. Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure the yearly reports are prepared and reviewed by separate individuals with evidence of review documented and retained, which could lead to inaccurate information being reported. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure the yearly reports, UDS Clinical Measures Report and Financial Report, are prepared and reviewed by separate individuals with evidence of review documented prior to submission. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that performance reports are prepared and reviewed by separate individuals. Documentation will be maintained by the program to evidence preparation and review processes and timely filing of annual report.
Finding Number 2023-004: Contract Requirements - Earmarking (Significant Deficiency over Internal Control and Instances of Noncompliance over Major Federal Program – Matching, Level of Effort and Earmarking) FALN Number 93.959 Block Grants for Prevention and Treatment of Substance Abuse, Award Number 900077, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.303(a) stated that the 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 terms and conditions of the federal award. Condition/Context: As a result of our audit procedures, we noted management did not have evidence retained to support its compliance with the program’s earmarking requirements related to process objectives, quality objectives and impact objectives. Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure the fulfillment of the earmarking requirements are properly documented, which led to non-compliance with program requirements. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to clearly identify the earmarking requirements of the program and retain proper documentations to support how the requirements are fulfilled. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will implement policies and procedures to ensure earmarking requirements are completed and evidence of review documented
Finding Number 2023-005: Contract Requirement – Reporting (Significant Deficiency over Internal Control and Instances of Noncompliance – Reporting) FALN Number 93.959 Block Grants for Prevention and Treatment of Substance Abuse, Award Number 900077, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.303(a) stated that the 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 terms and conditions of the federal award. Condition/Context: As a result of our audit procedures, we noted management did not have evidence to support its compliance with the program contract’s Third-Quarter Financial Report and the Quarterly Program Report requirements. Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure the required reports are properly prepared, reviewed and submitted timely. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to clearly identify all reporting requirements of the program to ensure all reports are prepared accurately and submitted timely. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that required reports are prepared and reviewed by separate individuals. Documentation will be maintained by the program to evidence preparation and review processes and timely filing of required reports.
Finding Number 2023-006: Costs Incurred Outside Period of Performance (Significant Deficiency over Internal Control and Instances of Noncompliance – Period of Performance; Allowable Costs/Cost Principles) FALN Number 93.959 Block Grants for Prevention and Treatment of Substance Abuse, Award Number 900077, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.403(h) stated that a non-federal entity may charge only allowable costs incurred during the approved budget period of a federal award’s period of performance. Condition/Context: As a result of our audit procedures, we noted 2 of 25 timesheets tested in which the costs incurred were charged outside of the program’s performance period. The two timesheets had payroll costs incurred during the pay period of 6/12/2022 – 6/25/2022; however, the contract had a performance period of 7/1/2022 – 6/30/2023. Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure only costs incurred in the performance period were charged to the program, which resulted in non-compliance with program requirements. Questioned Cost: None Recommendation: We recommend management review policies and procedures of the program to ensure the costs incurred are appropriately charged based on the contracts’ performance periods. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that costs incurred are appropriately charged based on the contracts’ performance periods.
Finding Number 2023-007: Costs Incurred Outside Period of Performance (Significant Deficiency over Internal Control and Instances of Noncompliance – Period of Performance; Allowable Costs/Cost Principles) FALN Number 16.575 U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance, Award Number 94-3302014, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.403(h) stated that a non-federal entity may charge only allowable costs incurred during the approved budget period of a federal award’s period of performance. Condition/Context: As a result of our audit procedures to evaluate the summary schedule of prior audit findings, we noted 1 sample of payroll expenditure of $6,561 incurred during the pay period 3/19/2023 – 4/1/2023; however, the payroll costs incurred was charged to the program based on the pay date instead of the pay period incurred. Repeat Finding from Prior Year(s): Yes, Finding Number 2022-003 Cause and Effect: The Health System did not have proper controls in place to ensure only costs incurred in the period of performance were charged to the program, which resulted in costs outside of period of performance being charged to the program. Questioned Cost: None Recommendation: We recommend management review policies and procedures of the program to ensure the costs incurred are appropriately charged based on the contracts’ performance periods. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that costs incurred are appropriately charged based on the contracts’ performance periods.
Finding Number 2023-008: Duplicate Charges (Significant Deficiency over Internal Control and Instances of Noncompliance – Allowable Costs/Cost Principles) FALN Number 16.575 U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance, Award Number 94-3302014, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.303(a) stated that the 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 terms and conditions of the federal award. Condition/Context: As a result of our audit procedures to evaluate the summary schedule of prior audit findings, we noted 1 sample of a $2,444 non-payroll expenditure had been duplicated on invoices remitted to the grantor. Repeat Finding from Prior Year(s): Yes, Finding Number 2022-004 Cause and Effect: The Health System did not have proper controls in place to prevent duplicate transactions from being entered into the system and charged to the program, which resulted in duplicate costs being charged to the program. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to prevent duplicate transactions from being charged to the program. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to prevent duplicate transactions from being charged to the program.
Finding Number 2023-009: Costs Incurred & Paid Prior to Reimbursements (Significant Deficiency over Internal Control and Instance of Noncompliance – Cash Management; Period of Performance) FALN Number 16.575 U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance, Award Number 94-3302014, Award Year 2022-2023 Criteria: 2023 Compliance Supplement stated that program costs must be paid by non-federal entity funds before submitting a payment request (2 CFR section 200.305(b)(3)) (i.e., the non-federal entity must disburse funds for program purposes before requesting payment from the federal awarding agency or pass-through entity). In addition, a non-federal entity may charge only allowable costs incurred during the approved budget period of a federal award’s period of performance. Condition/Context: As a result of our audit procedures to evaluate the summary schedule of prior audit findings, we noted 1 sample of $1,000 nonpayroll expenditures that was submitted for reimbursement prior to the expenditure being incurred. Repeat Finding from Prior Year(s): Yes, Finding Number 2022-007 Cause and Effect: The Health System did not have proper controls in place to ensure expenditures are incurred and paid for prior to reimbursements, and that expenditures are incurred within the period of performance of the contract, which resulted in noncompliance with the compliance requirements of the program. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure funds are disbursed for expenditures incurred prior to reimbursement requests, and that expenditures are incurred within the contract’s performance period. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure funds are disbursed for expenditures incurred prior to requesting reimbursement and that expenditures are incurred within the contract’s performance period.
Finding Number 2023-010: Reporting (Significant Deficiency over Internal Control and Instances of Noncompliance – Reporting) FALN Number 16.575 U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance, Award Number 94-3302014, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.303(a) stated that the 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 terms and conditions of the federal award. Condition/Context: As a result of our audit procedures to evaluate the summary schedule of prior audit findings, we noted 1 sample of untimely financial reporting submitting to the grantor. The financial report was for the quarter ended 3/31/2023 with a due date of 30 days after the reporting period; however, the report was submitted on 6/13/2023. We also noted 1 sample of performance report for the quarter ended 3/31/2023 that did not have clear evidence of preparer and reviewer of the report. Repeat Finding from Prior Year(s): Yes, Finding Number 2022-008 Cause and Effect: The Health System did not have proper controls in place to ensure the performance reports are prepared and reviewed by separate individuals with evidence of review documented and retained, which could lead to inaccurate information being reported. In addition, the Health System did not have proper controls in place to ensure financial reports are submitted timely with underlying support properly documented, which resulted in untimely reporting filing. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure performance reports are prepared and reviewed by separate individuals with evidence of review documented and that financial reports are submitted timely with underlying support properly documented. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that required reports are prepared and reviewed by separate individuals. Documentation will be maintained by the program to evidence preparation and review processes and timely filing of required reports.
Finding Number 2023-002: Timesheet vs. Time Study Hours (Significant Deficiency over Internal Control and Instance of Noncompliance – Allowable Costs/Cost Principles) FALN Number 93.778 Alameda Health Care Services Agency - Medical Assistance Program (Medi-Cal Administrative Activities), Award Number MAA MOU 2022-2023, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.403(h) stated that a non-federal entity may charge only allowable costs incurred during the approved budget period of a federal award’s period of performance. Condition/Context: As a result of our audit procedures, we noted 1 of 40 timesheets tested in which the hours on the employee’s timesheet did not agree to the hours reported on the time study. We identified 2.5 hours of steward leave being reported on the timesheet but not the time study. Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure hours reported on the timesheet agree to the hours on the time study, which could lead to inaccurate hours being reported and disbursed to employees. Questioned Cost: None Recommendation: We recommend management review policies and procedures to ensure the hours reported on the timesheet agree to the hours on the time study. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that costs incurred are appropriately charged based on the contracts’ performance periods.
Finding Number 2023-003: Reporting (Significant Deficiency over Internal Control and Instances of Noncompliance – Reporting) FALN Number 93.224 Health Center Program (Community Health Centers, Migrant Health Centers, Health care for the Homeless, and Public Housing Primary Care), Award Number MAA MOU 2022-2023, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.303(a) stated that the 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 terms and conditions of the federal award. Condition/Context: As a result of our audit procedures over the yearly reports, we noted the Uniform Data System (UDS) Clinical Measures Report and Financial Report did not have evidence of management’s review prior to report submission. Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure the yearly reports are prepared and reviewed by separate individuals with evidence of review documented and retained, which could lead to inaccurate information being reported. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure the yearly reports, UDS Clinical Measures Report and Financial Report, are prepared and reviewed by separate individuals with evidence of review documented prior to submission. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that performance reports are prepared and reviewed by separate individuals. Documentation will be maintained by the program to evidence preparation and review processes and timely filing of annual report.
Finding Number 2023-004: Contract Requirements - Earmarking (Significant Deficiency over Internal Control and Instances of Noncompliance over Major Federal Program – Matching, Level of Effort and Earmarking) FALN Number 93.959 Block Grants for Prevention and Treatment of Substance Abuse, Award Number 900077, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.303(a) stated that the 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 terms and conditions of the federal award. Condition/Context: As a result of our audit procedures, we noted management did not have evidence retained to support its compliance with the program’s earmarking requirements related to process objectives, quality objectives and impact objectives. Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure the fulfillment of the earmarking requirements are properly documented, which led to non-compliance with program requirements. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to clearly identify the earmarking requirements of the program and retain proper documentations to support how the requirements are fulfilled. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will implement policies and procedures to ensure earmarking requirements are completed and evidence of review documented
Finding Number 2023-005: Contract Requirement – Reporting (Significant Deficiency over Internal Control and Instances of Noncompliance – Reporting) FALN Number 93.959 Block Grants for Prevention and Treatment of Substance Abuse, Award Number 900077, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.303(a) stated that the 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 terms and conditions of the federal award. Condition/Context: As a result of our audit procedures, we noted management did not have evidence to support its compliance with the program contract’s Third-Quarter Financial Report and the Quarterly Program Report requirements. Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure the required reports are properly prepared, reviewed and submitted timely. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to clearly identify all reporting requirements of the program to ensure all reports are prepared accurately and submitted timely. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that required reports are prepared and reviewed by separate individuals. Documentation will be maintained by the program to evidence preparation and review processes and timely filing of required reports.
Finding Number 2023-006: Costs Incurred Outside Period of Performance (Significant Deficiency over Internal Control and Instances of Noncompliance – Period of Performance; Allowable Costs/Cost Principles) FALN Number 93.959 Block Grants for Prevention and Treatment of Substance Abuse, Award Number 900077, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.403(h) stated that a non-federal entity may charge only allowable costs incurred during the approved budget period of a federal award’s period of performance. Condition/Context: As a result of our audit procedures, we noted 2 of 25 timesheets tested in which the costs incurred were charged outside of the program’s performance period. The two timesheets had payroll costs incurred during the pay period of 6/12/2022 – 6/25/2022; however, the contract had a performance period of 7/1/2022 – 6/30/2023. Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure only costs incurred in the performance period were charged to the program, which resulted in non-compliance with program requirements. Questioned Cost: None Recommendation: We recommend management review policies and procedures of the program to ensure the costs incurred are appropriately charged based on the contracts’ performance periods. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that costs incurred are appropriately charged based on the contracts’ performance periods.
Finding Number 2023-007: Costs Incurred Outside Period of Performance (Significant Deficiency over Internal Control and Instances of Noncompliance – Period of Performance; Allowable Costs/Cost Principles) FALN Number 16.575 U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance, Award Number 94-3302014, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.403(h) stated that a non-federal entity may charge only allowable costs incurred during the approved budget period of a federal award’s period of performance. Condition/Context: As a result of our audit procedures to evaluate the summary schedule of prior audit findings, we noted 1 sample of payroll expenditure of $6,561 incurred during the pay period 3/19/2023 – 4/1/2023; however, the payroll costs incurred was charged to the program based on the pay date instead of the pay period incurred. Repeat Finding from Prior Year(s): Yes, Finding Number 2022-003 Cause and Effect: The Health System did not have proper controls in place to ensure only costs incurred in the period of performance were charged to the program, which resulted in costs outside of period of performance being charged to the program. Questioned Cost: None Recommendation: We recommend management review policies and procedures of the program to ensure the costs incurred are appropriately charged based on the contracts’ performance periods. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that costs incurred are appropriately charged based on the contracts’ performance periods.
Finding Number 2023-008: Duplicate Charges (Significant Deficiency over Internal Control and Instances of Noncompliance – Allowable Costs/Cost Principles) FALN Number 16.575 U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance, Award Number 94-3302014, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.303(a) stated that the 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 terms and conditions of the federal award. Condition/Context: As a result of our audit procedures to evaluate the summary schedule of prior audit findings, we noted 1 sample of a $2,444 non-payroll expenditure had been duplicated on invoices remitted to the grantor. Repeat Finding from Prior Year(s): Yes, Finding Number 2022-004 Cause and Effect: The Health System did not have proper controls in place to prevent duplicate transactions from being entered into the system and charged to the program, which resulted in duplicate costs being charged to the program. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to prevent duplicate transactions from being charged to the program. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to prevent duplicate transactions from being charged to the program.
Finding Number 2023-009: Costs Incurred & Paid Prior to Reimbursements (Significant Deficiency over Internal Control and Instance of Noncompliance – Cash Management; Period of Performance) FALN Number 16.575 U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance, Award Number 94-3302014, Award Year 2022-2023 Criteria: 2023 Compliance Supplement stated that program costs must be paid by non-federal entity funds before submitting a payment request (2 CFR section 200.305(b)(3)) (i.e., the non-federal entity must disburse funds for program purposes before requesting payment from the federal awarding agency or pass-through entity). In addition, a non-federal entity may charge only allowable costs incurred during the approved budget period of a federal award’s period of performance. Condition/Context: As a result of our audit procedures to evaluate the summary schedule of prior audit findings, we noted 1 sample of $1,000 nonpayroll expenditures that was submitted for reimbursement prior to the expenditure being incurred. Repeat Finding from Prior Year(s): Yes, Finding Number 2022-007 Cause and Effect: The Health System did not have proper controls in place to ensure expenditures are incurred and paid for prior to reimbursements, and that expenditures are incurred within the period of performance of the contract, which resulted in noncompliance with the compliance requirements of the program. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure funds are disbursed for expenditures incurred prior to reimbursement requests, and that expenditures are incurred within the contract’s performance period. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure funds are disbursed for expenditures incurred prior to requesting reimbursement and that expenditures are incurred within the contract’s performance period.
Finding Number 2023-010: Reporting (Significant Deficiency over Internal Control and Instances of Noncompliance – Reporting) FALN Number 16.575 U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance, Award Number 94-3302014, Award Year 2022-2023 Criteria: 2023 Compliance Supplement and 2 CFR 200.303(a) stated that the 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 terms and conditions of the federal award. Condition/Context: As a result of our audit procedures to evaluate the summary schedule of prior audit findings, we noted 1 sample of untimely financial reporting submitting to the grantor. The financial report was for the quarter ended 3/31/2023 with a due date of 30 days after the reporting period; however, the report was submitted on 6/13/2023. We also noted 1 sample of performance report for the quarter ended 3/31/2023 that did not have clear evidence of preparer and reviewer of the report. Repeat Finding from Prior Year(s): Yes, Finding Number 2022-008 Cause and Effect: The Health System did not have proper controls in place to ensure the performance reports are prepared and reviewed by separate individuals with evidence of review documented and retained, which could lead to inaccurate information being reported. In addition, the Health System did not have proper controls in place to ensure financial reports are submitted timely with underlying support properly documented, which resulted in untimely reporting filing. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure performance reports are prepared and reviewed by separate individuals with evidence of review documented and that financial reports are submitted timely with underlying support properly documented. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will review, modify, and implement policies and procedures over the program to ensure that required reports are prepared and reviewed by separate individuals. Documentation will be maintained by the program to evidence preparation and review processes and timely filing of required reports.