FAC Explorer

Audit 317105

FY End
2023-12-31
Total Expended
$26.52M
Findings
4
Programs
28
Organization: Indiana University Health, Inc. and Subsidiaries (IN)
Year: 2023 Accepted: 2024-08-13
Auditor: Ernst & Young

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
480996 2023-001 - - E
480997 2023-002 Significant Deficiency - L
1057438 2023-001 - - E
1057439 2023-002 Significant Deficiency - L

Programs

ALN Program Spent Major Findings
93.498 Provider Relief Fund $15.94M Yes 0
93.917 Hiv Care Formula Grants $2.65M Yes 0
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $1.73M Yes 1
14.241 Housing Opportunities for Persons with Aids $1.20M Yes 1
93.767 Children's Health Insurance Program $698,726 - 0
93.253 Poison Center Support and Enhancement Grant $605,947 - 0
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $488,487 - 0
93.866 Aging Research $423,834 - 0
93.940 Hiv Prevention Activities_health Department Based $409,083 - 0
93.211 Telehealth Programs $348,722 - 0
14.267 Continuum of Care Program $297,072 - 0
32.006 Covid-19 Telehealth Program $249,879 - 0
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $201,317 - 0
93.914 Hiv Emergency Relief Project Grants $188,985 - 0
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $147,634 - 0
16.560 National Institute of Justice Research, Evaluation, and Development Project Grants $144,574 - 0
93.959 Block Grants for Prevention and Treatment of Substance Abuse $128,200 - 0
93.994 Maternal and Child Health Services Block Grant to the States $105,199 - 0
93.889 National Bioterrorism Hospital Preparedness Program $94,495 - 0
16.575 Crime Victim Assistance $88,532 - 0
93.461 Covid-19 Testing for the Uninsured $64,002 - 0
93.969 Pphf Geriatric Education Centers $43,333 - 0
93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research $32,896 - 0
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $32,500 - 0
93.270 Adult Viral Hepatitis Prevention and Control $16,026 - 0
93.838 Lung Diseases Research $10,100 - 0
93.941 Hiv Demonstration, Research, Public and Professional Education Projects $5,726 - 0
93.837 Cardiovascular Diseases Research $200 - 0

Contacts

Name Title Type
SN26MRT2DNJ5 Christine Smith Auditee
3179624160 Myka Rusnak Auditor
No contacts on file

Notes to SEFA

Title: 1. Significant Accounting Policies Used in Preparing the Schedule of Expenditures of Federal Awards Accounting Policies: Indiana University Health, Inc. and Subsidiaries’ (Indiana University Health) schedule of expenditures of federal awards (the Schedule) for the year ended December 31, 2023, includes all federal programs administered by the entities included in Indiana University Health, Inc.’s reporting entity with the following exceptions. Federal expenditures in the amount of $266,584 are not presented in the Schedule because Rehabilitation Hospital of Indiana, Inc. engages other auditors to perform audits in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principle, and Audit Requirements for Federal Awards (Uniform Guidance), when $750,000 of federal funds or more are expended. The Schedule is presented on the accrual basis of accounting. Expenditures are recorded, accordingly, when incurred rather than when paid. The information in this Schedule is presented in accordance with the requirements of the Uniform Guidance. Therefore, some amounts presented in the Schedule may differ from amounts presented in or used in the preparation of the consolidated financial statements. De Minimis Rate Used: Both Rate Explanation: Indirect cost rates for Indiana University Health were based on applicable U.S. Department of Health and Human Services (HHS) negotiated rates, the 10% de minimis cost rate allowed by the Uniform Guidance, or sponsor-specific (capped) rates. Indiana University Health, Inc. and Subsidiaries’ (Indiana University Health) schedule of expenditures of federal awards (the Schedule) for the year ended December 31, 2023, includes all federal programs administered by the entities included in Indiana University Health, Inc.’s reporting entity with the following exceptions. Federal expenditures in the amount of $266,584 are not presented in the Schedule because Rehabilitation Hospital of Indiana, Inc. engages other auditors to perform audits in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principle, and Audit Requirements for Federal Awards (Uniform Guidance), when $750,000 of federal funds or more are expended. The Schedule is presented on the accrual basis of accounting. Expenditures are recorded, accordingly, when incurred rather than when paid. The information in this Schedule is presented in accordance with the requirements of the Uniform Guidance. Therefore, some amounts presented in the Schedule may differ from amounts presented in or used in the preparation of the consolidated financial statements.
Title: 2. Indirect Costs Accounting Policies: Indiana University Health, Inc. and Subsidiaries’ (Indiana University Health) schedule of expenditures of federal awards (the Schedule) for the year ended December 31, 2023, includes all federal programs administered by the entities included in Indiana University Health, Inc.’s reporting entity with the following exceptions. Federal expenditures in the amount of $266,584 are not presented in the Schedule because Rehabilitation Hospital of Indiana, Inc. engages other auditors to perform audits in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principle, and Audit Requirements for Federal Awards (Uniform Guidance), when $750,000 of federal funds or more are expended. The Schedule is presented on the accrual basis of accounting. Expenditures are recorded, accordingly, when incurred rather than when paid. The information in this Schedule is presented in accordance with the requirements of the Uniform Guidance. Therefore, some amounts presented in the Schedule may differ from amounts presented in or used in the preparation of the consolidated financial statements. De Minimis Rate Used: Both Rate Explanation: Indirect cost rates for Indiana University Health were based on applicable U.S. Department of Health and Human Services (HHS) negotiated rates, the 10% de minimis cost rate allowed by the Uniform Guidance, or sponsor-specific (capped) rates. Indirect cost rates for Indiana University Health were based on applicable U.S. Department of Health and Human Services (HHS) negotiated rates, the 10% de minimis cost rate allowed by the Uniform Guidance, or sponsor-specific (capped) rates.
Title: 3. Special Supplemental Nutrition Program for Women, Infants, and Children (Assistance Listing No. 10.557) Accounting Policies: Indiana University Health, Inc. and Subsidiaries’ (Indiana University Health) schedule of expenditures of federal awards (the Schedule) for the year ended December 31, 2023, includes all federal programs administered by the entities included in Indiana University Health, Inc.’s reporting entity with the following exceptions. Federal expenditures in the amount of $266,584 are not presented in the Schedule because Rehabilitation Hospital of Indiana, Inc. engages other auditors to perform audits in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principle, and Audit Requirements for Federal Awards (Uniform Guidance), when $750,000 of federal funds or more are expended. The Schedule is presented on the accrual basis of accounting. Expenditures are recorded, accordingly, when incurred rather than when paid. The information in this Schedule is presented in accordance with the requirements of the Uniform Guidance. Therefore, some amounts presented in the Schedule may differ from amounts presented in or used in the preparation of the consolidated financial statements. De Minimis Rate Used: Both Rate Explanation: Indirect cost rates for Indiana University Health were based on applicable U.S. Department of Health and Human Services (HHS) negotiated rates, the 10% de minimis cost rate allowed by the Uniform Guidance, or sponsor-specific (capped) rates. The objective of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is to provide, at no cost, supplemental nutritious foods, nutrition education, and referrals of health care to low-income pregnant, breast-feeding, and postpartum women, infants, and children to age five determined to be at nutritional risk. In addition to direct payments received for the year ended December 31, 2023, Indiana University Health distributed WIC food vouchers with an indeterminable value. This activity has not been reflected in the consolidated financial statements of Indiana University Health or on the schedule of expenditures of federal awards, as the redemption of the food vouchers is not processed by Indiana University Health.
Title: 4. COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution (Assistance Listing No. 93.498) Accounting Policies: Indiana University Health, Inc. and Subsidiaries’ (Indiana University Health) schedule of expenditures of federal awards (the Schedule) for the year ended December 31, 2023, includes all federal programs administered by the entities included in Indiana University Health, Inc.’s reporting entity with the following exceptions. Federal expenditures in the amount of $266,584 are not presented in the Schedule because Rehabilitation Hospital of Indiana, Inc. engages other auditors to perform audits in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principle, and Audit Requirements for Federal Awards (Uniform Guidance), when $750,000 of federal funds or more are expended. The Schedule is presented on the accrual basis of accounting. Expenditures are recorded, accordingly, when incurred rather than when paid. The information in this Schedule is presented in accordance with the requirements of the Uniform Guidance. Therefore, some amounts presented in the Schedule may differ from amounts presented in or used in the preparation of the consolidated financial statements. De Minimis Rate Used: Both Rate Explanation: Indirect cost rates for Indiana University Health were based on applicable U.S. Department of Health and Human Services (HHS) negotiated rates, the 10% de minimis cost rate allowed by the Uniform Guidance, or sponsor-specific (capped) rates. The Schedule includes $15,939,771 received from HHS between January 1, 2022, and June 30, 2022, under the COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF) Assistance Listing No. 93.498  . In accordance with guidance from HHS, these amounts are presented as Period 5 in the HHS PRF Reporting Portal. Such amounts were recognized as other revenue in the Indiana University Health’s consolidated financial statements on the accompanying consolidated statements of operations and changes in net assets for the year ended December 31, 2022. Due to the PRF Reporting Portal requirements, this amount is not the total PRF received and/or recognized by Indiana University Health as other revenue in the consolidated financial statements for the year ended December 31, 2022. The amount presented on the Schedule for PRF is for the fiscal year ended December 31, 2023. The amount presented reconciles to the PRF information reported to HHS as follows: “See the Notes to the SEFA for chart/table”

Finding Details

Finding 2023-001
Finding 2023-001 (Scope Limitation – E. Eligibility) Identification of the federal program: Federal Agency: United States Department of Agriculture Assistance Listing No.: 10.557 – Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Pass-through Entity and Award Periods: Indiana Department of Health – October 1, 2022 through September 30, 2023 and October 1, 2023 through September 30, 2024 Criteria or specific requirement (including statutory, regulatory or other citation): Applicants for WIC Program benefits are screened at WIC clinic sites to determine their WIC eligibility. To be a certified eligible, they must meet various eligibility criteria as outlined in 7 CFR sections 246.7(c), (d), (e), (g), and (l). When an applicant meets all eligibility criteria, he/she is determined by WIC clinic staff to be eligible for program benefits. Certification periods are assigned to each participant based on categorical status for women, infants, and children (7 CFR section 246.7(g)). A WIC local agency assigns each eligible person a priority classification according to the classification system described in 7 CFR section 246.7(e)(4). A person’s priority assignment reflects the severity of his/her nutritional risk. If the local agency cannot immediately place the person on the program for lack of an available caseload slot, the person is placed on a waiting list. Caseload vacancies are filled from the waiting list in priority classification order. State agencies are expected to target program outreach and caseload management efforts toward persons at greatest nutritional risk (i.e., those in the highest priority classifications). Condition: Indiana University Health, Inc. and Subsidiaries screen applicants for eligibility by following the State of Indiana guidelines as provided through the INWIC system used to enter, track, and store information about applicants. Based on guidance from the Department of Agriculture, states were encouraged to move to a paperless system. The State of Indiana has followed that guidance and does not require participating entities to retain copies of an applicant’s proof of residence, income, etc. regarding eligibility. Therefore, we were not able to test internal controls over compliance or compliance over the eligibility compliance requirement and have issued a qualified opinion based on the scope limitation. Cause: Indiana University Health, Inc. and Subsidiaries follow a paperless system as supported by the State of Indiana and the U.S. Department of Agriculture. Effect or potential effect: A scope limitation qualified opinion was issued for Assistance Listing No. 10.557 as we were unable to obtain sufficient documentation supporting the compliance of Indiana University Health, Inc. and Subsidiaries regarding eligibility. Questioned costs: None. Context: Federal expenditures reported in the schedule of expenditures of federal award for Assistance Listing No. 10.557 totaled $1,733,429 for the year ended December 31, 2023. Identification as a repeat finding, if applicable: This is a repeat of finding 2020-001. Recommendation: Not practical. Views of responsible officials: As Indiana University Health, Inc. and Subsidiaries follows the state of Indiana’s paperless system, as described above, which is also supported by 7 CFR 24, no further corrective action will be taken.
Finding 2023-002
Finding 2023-002 (L. Reporting) Identification of the federal program: Federal Agency: United States Department of Housing and Urban Development Assistance Listing No.: 14.241 – Housing Opportunities for Persons with AIDS (HOPWA) Pass-through Entities and Award Periods: Indiana Housing and Community Development Authority (IHCDA) – July 1, 2022 through June 30, 2023 and July 1, 2023 through June 30, 2024 and City of Indianapolis – April 1, 2022 through March 31, 2023 and April 1, 2024 through March 31, 2024 Criteria or specific requirement (Including statutory, regulatory or other citation): Section 200.303 of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) states the following regarding internal control: “The non-Federal entity must: (a) 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. These internal controls should be in compliance with guidance in “Standards for Internal Control in the Federal Government” issued by the Comptroller General of the United States or the “Internal Control Integrated Framework”, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO).” Under the grant agreements, HOPWA grantees are required to submit performance reporting, specifically a HUD-40-110-D, HOPWA Consolidated Annual Performance and Evaluation Report (CAPER), no later than 90 days after the close of the program or operating year, as required per 24 CFR section 574.520. Condition: The CAPER submission submitted by Indiana University Health, Inc. and Subsidiaries for the IHCDA grant for the period July 1, 2022 through June 30, 2023, incorrectly excluded $3,600 in funds expended on eligible activities (specifically, support services). For both the HOPWA CAPER submissions, the documentation retained did not support the extent of the review procedures performed prior to the CAPER submissions. Cause: Indiana University Health, Inc. and Subsidiaries’ internal control over the CAPER reporting process was not operating effectively during the year ended December 31, 2023. Effect or potential effect: Incorrect CAPER submissions were filed with HUD as a result of the control not operating effectively. Questioned costs: None. Context: Indiana University Health, Inc. and Subsidiaries submitted two CAPER reports during the year ended December 31, 2023. EY tested both CAPER reports for testing of internal controls over compliance and compliance for HOPWA reporting. The CAPER submission for the IHCDA grant for the period July 1, 2022 through June 30, 2023, incorrectly excluded $3,600 in funds expended on eligible activities. The documentation retained for both reports filed did not support the extent of the review procedures performed prior to the CAPER submissions. Total federal expenditures for Assistance Listing No. 14.241 totaled $1,201,378 for the year ended December 31, 2023. Identification as a repeat finding, if applicable: This is not a repeat finding. Recommendation: Indiana University Health, Inc. and Subsidiaries should ensure the completed CAPER and underlying support are sufficiently reviewed to identify discrepancies and documentation of those review procedures are maintained prior to submitting the CAPER. Views of responsible officials: Indiana University Health, Inc. and Subsidiaries believes it appropriately designed procedures and internal controls over the HOPWA reporting requirements. Indiana University Health, Inc. and Subsidiaries agrees that the CAPER submission for the IHCDA grant for the period of July 1, 2022 through June 30, 2023, contained incomplete and inaccurate information. Indiana University Health, Inc. has revisited the internal control over HOPWA performance reporting
Finding 2023-001
Finding 2023-001 (Scope Limitation – E. Eligibility) Identification of the federal program: Federal Agency: United States Department of Agriculture Assistance Listing No.: 10.557 – Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Pass-through Entity and Award Periods: Indiana Department of Health – October 1, 2022 through September 30, 2023 and October 1, 2023 through September 30, 2024 Criteria or specific requirement (including statutory, regulatory or other citation): Applicants for WIC Program benefits are screened at WIC clinic sites to determine their WIC eligibility. To be a certified eligible, they must meet various eligibility criteria as outlined in 7 CFR sections 246.7(c), (d), (e), (g), and (l). When an applicant meets all eligibility criteria, he/she is determined by WIC clinic staff to be eligible for program benefits. Certification periods are assigned to each participant based on categorical status for women, infants, and children (7 CFR section 246.7(g)). A WIC local agency assigns each eligible person a priority classification according to the classification system described in 7 CFR section 246.7(e)(4). A person’s priority assignment reflects the severity of his/her nutritional risk. If the local agency cannot immediately place the person on the program for lack of an available caseload slot, the person is placed on a waiting list. Caseload vacancies are filled from the waiting list in priority classification order. State agencies are expected to target program outreach and caseload management efforts toward persons at greatest nutritional risk (i.e., those in the highest priority classifications). Condition: Indiana University Health, Inc. and Subsidiaries screen applicants for eligibility by following the State of Indiana guidelines as provided through the INWIC system used to enter, track, and store information about applicants. Based on guidance from the Department of Agriculture, states were encouraged to move to a paperless system. The State of Indiana has followed that guidance and does not require participating entities to retain copies of an applicant’s proof of residence, income, etc. regarding eligibility. Therefore, we were not able to test internal controls over compliance or compliance over the eligibility compliance requirement and have issued a qualified opinion based on the scope limitation. Cause: Indiana University Health, Inc. and Subsidiaries follow a paperless system as supported by the State of Indiana and the U.S. Department of Agriculture. Effect or potential effect: A scope limitation qualified opinion was issued for Assistance Listing No. 10.557 as we were unable to obtain sufficient documentation supporting the compliance of Indiana University Health, Inc. and Subsidiaries regarding eligibility. Questioned costs: None. Context: Federal expenditures reported in the schedule of expenditures of federal award for Assistance Listing No. 10.557 totaled $1,733,429 for the year ended December 31, 2023. Identification as a repeat finding, if applicable: This is a repeat of finding 2020-001. Recommendation: Not practical. Views of responsible officials: As Indiana University Health, Inc. and Subsidiaries follows the state of Indiana’s paperless system, as described above, which is also supported by 7 CFR 24, no further corrective action will be taken.
Finding 2023-002
Finding 2023-002 (L. Reporting) Identification of the federal program: Federal Agency: United States Department of Housing and Urban Development Assistance Listing No.: 14.241 – Housing Opportunities for Persons with AIDS (HOPWA) Pass-through Entities and Award Periods: Indiana Housing and Community Development Authority (IHCDA) – July 1, 2022 through June 30, 2023 and July 1, 2023 through June 30, 2024 and City of Indianapolis – April 1, 2022 through March 31, 2023 and April 1, 2024 through March 31, 2024 Criteria or specific requirement (Including statutory, regulatory or other citation): Section 200.303 of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) states the following regarding internal control: “The non-Federal entity must: (a) 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. These internal controls should be in compliance with guidance in “Standards for Internal Control in the Federal Government” issued by the Comptroller General of the United States or the “Internal Control Integrated Framework”, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO).” Under the grant agreements, HOPWA grantees are required to submit performance reporting, specifically a HUD-40-110-D, HOPWA Consolidated Annual Performance and Evaluation Report (CAPER), no later than 90 days after the close of the program or operating year, as required per 24 CFR section 574.520. Condition: The CAPER submission submitted by Indiana University Health, Inc. and Subsidiaries for the IHCDA grant for the period July 1, 2022 through June 30, 2023, incorrectly excluded $3,600 in funds expended on eligible activities (specifically, support services). For both the HOPWA CAPER submissions, the documentation retained did not support the extent of the review procedures performed prior to the CAPER submissions. Cause: Indiana University Health, Inc. and Subsidiaries’ internal control over the CAPER reporting process was not operating effectively during the year ended December 31, 2023. Effect or potential effect: Incorrect CAPER submissions were filed with HUD as a result of the control not operating effectively. Questioned costs: None. Context: Indiana University Health, Inc. and Subsidiaries submitted two CAPER reports during the year ended December 31, 2023. EY tested both CAPER reports for testing of internal controls over compliance and compliance for HOPWA reporting. The CAPER submission for the IHCDA grant for the period July 1, 2022 through June 30, 2023, incorrectly excluded $3,600 in funds expended on eligible activities. The documentation retained for both reports filed did not support the extent of the review procedures performed prior to the CAPER submissions. Total federal expenditures for Assistance Listing No. 14.241 totaled $1,201,378 for the year ended December 31, 2023. Identification as a repeat finding, if applicable: This is not a repeat finding. Recommendation: Indiana University Health, Inc. and Subsidiaries should ensure the completed CAPER and underlying support are sufficiently reviewed to identify discrepancies and documentation of those review procedures are maintained prior to submitting the CAPER. Views of responsible officials: Indiana University Health, Inc. and Subsidiaries believes it appropriately designed procedures and internal controls over the HOPWA reporting requirements. Indiana University Health, Inc. and Subsidiaries agrees that the CAPER submission for the IHCDA grant for the period of July 1, 2022 through June 30, 2023, contained incomplete and inaccurate information. Indiana University Health, Inc. has revisited the internal control over HOPWA performance reporting