FAC Explorer

Audit 332508

FY End
2024-06-30
Total Expended
$10.48M
Findings
12
Programs
15
Organization: Alameda Health System, A Public Hospital Authority (CA)
Year: 2024 Accepted: 2024-12-13
Auditor: Moss Adams LLP

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
514260 2024-002 Significant Deficiency Yes B
514261 2024-003 Significant Deficiency Yes G
514262 2024-004 Significant Deficiency Yes H
514263 2024-005 Significant Deficiency Yes L
514264 2024-006 Significant Deficiency - B
514265 2024-007 Significant Deficiency - L
1090702 2024-002 Significant Deficiency Yes B
1090703 2024-003 Significant Deficiency Yes G
1090704 2024-004 Significant Deficiency Yes H
1090705 2024-005 Significant Deficiency Yes L
1090706 2024-006 Significant Deficiency - B
1090707 2024-007 Significant Deficiency - L

Programs

ALN Program Spent Major Findings
93.778 Medical Assistance Program $3.81M Yes 1
16.575 Crime Victim Assistance $1.23M Yes 3
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $1.07M Yes 1
93.224 Community Health Centers $950,721 - 0
93.959 Block Grants for Prevention and Treatment of Substance Abuse $884,692 - 1
93.917 Hiv Care Formula Grants $420,048 - 0
93.918 Grants to Provide Outpatient Early Intervention Services with Respect to Hiv Disease $407,659 - 0
17.259 Wioa Youth Activities $155,141 - 0
93.153 Coordinated Services and Access to Research for Women, Infants, Children, and Youth $147,124 - 0
93.924 Ryan White Hiv/aids Dental Reimbursements $69,688 - 0
93.145 Aids Education and Training Centers $64,181 - 0
93.914 Hiv Emergency Relief Project Grants $62,662 - 0
93.732 Mental and Behavioral Health Education and Training Grants $62,287 - 0
93.497 Family Violence Prevention and Services/ Sexual Assault/rape Crisis Services and Supports $23,131 - 0
93.279 Drug Abuse and Addiction Research Programs $14,614 - 0

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 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. De Minimis Rate Used: N Rate Explanation: 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 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. De Minimis Rate Used: N Rate Explanation: 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.
Title: Note 3 – Relationship to the Basic Financial Statements Accounting Policies: 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. De Minimis Rate Used: N Rate Explanation: 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 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. De Minimis Rate Used: N Rate Explanation: 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 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. De Minimis Rate Used: N Rate Explanation: 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, 2024.
Title: Note 6 – Indirect Costs Accounting Policies: 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. De Minimis Rate Used: N Rate Explanation: The Health System negotiates indirect cost rates separately for each contract. The Health System has not elected to use the 10 percent de minimis 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 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. De Minimis Rate Used: N Rate Explanation: 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 - RC22 38 1146, and Federal Expenditures of $269,648; 2) Rape Crisis Program, Contract Number - RC23 39 1146, and Federal Expenditures of $510,827; 3) Sexual Assault Response Team Program, Contract Number - XS22 05 1146, and Federal Expenditures of $83,968; 4) Sexual Assault Response Team Program, Contract Number - XS23 06 1146, and Federal Expenditures of $49,252; 5) Specialized Emergency Housing Program, Contract Number - KE22 01 1146, and Federal Expenditures of $178,199; 6) Specialized Emergency Housing Program, Contract Number - KE23 03 1146, and Federal Expenditures of $141,961, and 7) Total Federal Expenditures of $1,233,855.

Finding Details

Finding 2024-002
Finding Number 2024-002: Timesheet versus Time Study Hours (Significant Deficiency in Internal Control over compliance – Allowable Costs/Cost Principles) FALN Number 93.778; Federal Agency/Pass-through Entity – Program Name Alameda Health Care Services Agency - Medical Assistance Program (Medi-Cal Administrative Activities); Award Number MAA MOU 2023-2024; Award Year 2023-2024 Criteria: 2024 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 nonfederal 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 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 as the time study was not prepared for an employee. Repeat Finding from Prior Year(s): Yes, Finding Number 2023-002 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 and that a time study is properly prepared, 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, and to ensure a time study is properly prepared and retained. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System finalized the standard work procedures titled, Internal Controls for Proper Verification, which include procedures to ensure reported timesheet hours agree to hours on the time study and costs incurred are appropriately charged based on the contracts’ performance periods. Staff is implementing policy in fiscal year 2025."
Finding 2024-003
Finding Number 2024-003: Contract Requirements - Earmarking (Significant Deficiency in Internal Control over compliance and Instance of Noncompliance – Matching, Level of Effort, and Earmarking) FALN Number 93.959; Federal Agency/Pass-through Entity – Program Name Block Grants for Prevention and Treatment of Substance Abuse; Award Number 900077; Award Year 2023-2024 Criteria: 2024 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): Yes, Finding Number 2023-004 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 has drafted the policy titled, Alameda Health System Reports Policies – SUD Program, to ensure earmarking requirements of the program and proper documentation is retained to evidence fulfilled requirements. The policy will be finalized in fiscal year 2025.
Finding 2024-004
Finding Number 2024-004: Costs Incurred Outside Period of Performance (Significant Deficiency in Internal Control over compliance and Instance of Noncompliance – Period of Performance) FALN Number 16.575; Federal Agency/Pass-through Entity – Program Name U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance; Award Number 94-3302014; Award Year 2023-2024 Criteria: 2024 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 timesheet tested in which the costs incurred were charged outside of the program’s performance period. The timesheet had payroll costs incurred during the pay period of 12/24/2023 – 1/6/2024; however, the contract had a performance period of 1/1/2024 – 12/31/2024. Repeat Finding from Prior Year(s): Yes, Finding Number 2023-007 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 has finalized the standard work procedure titled, Request for Funds/Reimbursement Claims (2-201’s), to ensure costs are appropriately charged based on the contract’s performance periods. Review of cost activity will occur in fiscal year 2025 to ensure policy is followed.
Finding 2024-005
Finding Number 2024-05: Untimely Reporting (Significant Deficiency in Internal Control over compliance and Instances of Noncompliance – Reporting) FALN Number 16.575; Federal Agency/Pass-through Entity – Program Name U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance; Award Number 94-3302014; Award Year 2023-2024 Criteria: 2024 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 1 sample of untimely financial reporting submitting to the grantor. The financial report was for the quarter ended 9/30/2023 with a due date of 30 days after the reporting period; however, the report was submitted on 11/8/2023. We also noted 2 samples of performance report for the quarters ended 12/31/2023 and 9/30/2023 with due dates of 30 days after the reporting period; however, the reports were submitted on 3/19/2024 and 11/2/2023, respectively. Repeat Finding from Prior Year(s): Yes, Finding Number 2023-010 Cause and Effect: The Health System did not have proper controls in place to ensure financial and performance reports are submitted timely, which resulted in late report filings. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure financial and performance reports are 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 annual report.
Finding 2024-006
Finding Number 2024-006: Charges Not Specified in Grant Contracts (Significant Deficiency in Internal Control over compliance and Instances of Noncompliance – Allowable Costs/Cost Principles) FALN Number 16.575; Federal Agency/Pass-through Entity – Program Name U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance; Award Number 94-3302014; Award Year 2023-2024 Criteria: 2024 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 7 samples totaling $190 non-payroll expenditure for gift card purchases that were not outlined in the grant contract (RC22). Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure expenditures being charged to the program are specifically identified in the grant contract. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure expenditures charged to the program are in accordance with the grant contracts. 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 expenditures being charged to the program are specifically identified in the grant contract.
Finding 2024-007
Finding Number 2024-007: FEMA Reporting (Significant Deficiency in Internal Control over compliance -Reporting) FALN Number 97.036; Federal Agency/Pass-through Entity – Program Name COVID 19 - Disaster Grants – Public Assistance (Presidentially Declared Disasters); Award Number FEMA-4482-DR-CA, Cal OES ID: 001-91020; Award Year 2023-2024 Criteria: 2024 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 the only reimbursement request submitted to the grantor did not have clear evidence of preparer and reviewer of the report. Repeat Finding from Prior Year(s): No. Cause and Effect: The Health System did not have proper controls in place to ensure reimbursement request is prepared and reviewed by separate individuals with evidence of review documented and retained, which could lead to inaccurate information being reported and or submitted for reimbursement. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure reimbursement request is prepared and reviewed by separate individuals with evidence of review documented. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will ensure that the FEMA reimbursement requests have clear evidence of the individuals preparing and reviewing of the submission. Documentation will be maintained to evidence preparation and review process.
Finding 2024-002
Finding Number 2024-002: Timesheet versus Time Study Hours (Significant Deficiency in Internal Control over compliance – Allowable Costs/Cost Principles) FALN Number 93.778; Federal Agency/Pass-through Entity – Program Name Alameda Health Care Services Agency - Medical Assistance Program (Medi-Cal Administrative Activities); Award Number MAA MOU 2023-2024; Award Year 2023-2024 Criteria: 2024 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 nonfederal 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 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 as the time study was not prepared for an employee. Repeat Finding from Prior Year(s): Yes, Finding Number 2023-002 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 and that a time study is properly prepared, 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, and to ensure a time study is properly prepared and retained. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System finalized the standard work procedures titled, Internal Controls for Proper Verification, which include procedures to ensure reported timesheet hours agree to hours on the time study and costs incurred are appropriately charged based on the contracts’ performance periods. Staff is implementing policy in fiscal year 2025."
Finding 2024-003
Finding Number 2024-003: Contract Requirements - Earmarking (Significant Deficiency in Internal Control over compliance and Instance of Noncompliance – Matching, Level of Effort, and Earmarking) FALN Number 93.959; Federal Agency/Pass-through Entity – Program Name Block Grants for Prevention and Treatment of Substance Abuse; Award Number 900077; Award Year 2023-2024 Criteria: 2024 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): Yes, Finding Number 2023-004 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 has drafted the policy titled, Alameda Health System Reports Policies – SUD Program, to ensure earmarking requirements of the program and proper documentation is retained to evidence fulfilled requirements. The policy will be finalized in fiscal year 2025.
Finding 2024-004
Finding Number 2024-004: Costs Incurred Outside Period of Performance (Significant Deficiency in Internal Control over compliance and Instance of Noncompliance – Period of Performance) FALN Number 16.575; Federal Agency/Pass-through Entity – Program Name U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance; Award Number 94-3302014; Award Year 2023-2024 Criteria: 2024 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 timesheet tested in which the costs incurred were charged outside of the program’s performance period. The timesheet had payroll costs incurred during the pay period of 12/24/2023 – 1/6/2024; however, the contract had a performance period of 1/1/2024 – 12/31/2024. Repeat Finding from Prior Year(s): Yes, Finding Number 2023-007 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 has finalized the standard work procedure titled, Request for Funds/Reimbursement Claims (2-201’s), to ensure costs are appropriately charged based on the contract’s performance periods. Review of cost activity will occur in fiscal year 2025 to ensure policy is followed.
Finding 2024-005
Finding Number 2024-05: Untimely Reporting (Significant Deficiency in Internal Control over compliance and Instances of Noncompliance – Reporting) FALN Number 16.575; Federal Agency/Pass-through Entity – Program Name U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance; Award Number 94-3302014; Award Year 2023-2024 Criteria: 2024 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 1 sample of untimely financial reporting submitting to the grantor. The financial report was for the quarter ended 9/30/2023 with a due date of 30 days after the reporting period; however, the report was submitted on 11/8/2023. We also noted 2 samples of performance report for the quarters ended 12/31/2023 and 9/30/2023 with due dates of 30 days after the reporting period; however, the reports were submitted on 3/19/2024 and 11/2/2023, respectively. Repeat Finding from Prior Year(s): Yes, Finding Number 2023-010 Cause and Effect: The Health System did not have proper controls in place to ensure financial and performance reports are submitted timely, which resulted in late report filings. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure financial and performance reports are 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 annual report.
Finding 2024-006
Finding Number 2024-006: Charges Not Specified in Grant Contracts (Significant Deficiency in Internal Control over compliance and Instances of Noncompliance – Allowable Costs/Cost Principles) FALN Number 16.575; Federal Agency/Pass-through Entity – Program Name U.S. Department of Justice, Office of Victims of Crime – Crime Victim Assistance; Award Number 94-3302014; Award Year 2023-2024 Criteria: 2024 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 7 samples totaling $190 non-payroll expenditure for gift card purchases that were not outlined in the grant contract (RC22). Repeat Finding from Prior Year(s): No Cause and Effect: The Health System did not have proper controls in place to ensure expenditures being charged to the program are specifically identified in the grant contract. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure expenditures charged to the program are in accordance with the grant contracts. 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 expenditures being charged to the program are specifically identified in the grant contract.
Finding 2024-007
Finding Number 2024-007: FEMA Reporting (Significant Deficiency in Internal Control over compliance -Reporting) FALN Number 97.036; Federal Agency/Pass-through Entity – Program Name COVID 19 - Disaster Grants – Public Assistance (Presidentially Declared Disasters); Award Number FEMA-4482-DR-CA, Cal OES ID: 001-91020; Award Year 2023-2024 Criteria: 2024 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 the only reimbursement request submitted to the grantor did not have clear evidence of preparer and reviewer of the report. Repeat Finding from Prior Year(s): No. Cause and Effect: The Health System did not have proper controls in place to ensure reimbursement request is prepared and reviewed by separate individuals with evidence of review documented and retained, which could lead to inaccurate information being reported and or submitted for reimbursement. Questioned Cost: None Recommendation: We recommend management implement policies and procedures to ensure reimbursement request is prepared and reviewed by separate individuals with evidence of review documented. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. The Health System will ensure that the FEMA reimbursement requests have clear evidence of the individuals preparing and reviewing of the submission. Documentation will be maintained to evidence preparation and review process.