Finding 21589 (2022-002)

Significant Deficiency
Requirement
J
Questioned Costs
$1
Year
2022
Accepted
2023-08-28

AI Summary

  • Core Issue: Flushing lacked formal controls to track and report program income from mental health services under the Demonstration Grant.
  • Impacted Requirements: The program income of $58,039 was not used to support eligible project objectives, violating the grant's compliance criteria.
  • Recommended Follow-Up: Implement controls to monitor program income, maintain documentation for its use, and notify HHS about the compliance issue.

Finding Text

2022-02: Significant Deficiency ? Program income compliance and controls Federal Agency: Department of Health and Human Services Program: Certified Community Behavioral Health Clinic Demonstration Grant Assistance Listing Number: 93.829 Criteria In accordance with the NoA, ?Recipients will add program income to funds committed to the project to further eligible project objectives.? Condition Flushing did not have a formal control in place to identify, monitor and report program income collected from providing mental health counseling services to patients under the Certified Community Behavioral Health Clinic Demonstration Grant (?Demonstration Grant?). Questioned Costs During the year ended December 31, 2022, Flushing collected program income of $58,039 from billings related to mental health counseling services provided under the Demonstration Grant. Management did not use program income to further eligible project objectives of the Demonstration Grant. However, the Demonstration Grant?s budget included $165,114 of allowable indirect costs over the award period (May 1, 2020 through December 3, 2022), for which Flushing did not request reimbursement. Cause The Demonstration Grant is Flushing?s only grant that includes a program income compliance requirement. Management?s inexperience with this compliance requirement led to the failure to identify the program income compliance requirement. As a result, Flushing did not design and implement controls over program income. Effect Management did not have a control in place to ensure compliance with the program income requirement of the Demonstration Grant and did not add the program income funds collected during the year ended December 31, 2022 to funds committed to further eligible project objectives, as required by the NoA. Recommendation We recommend Flushing design and implement formal controls around the program income compliance requirement for the Demonstration Grant. Specifically, we recommend management?s controls include performing the following activities on an ongoing basis: (1) Review patient-level program income reports for completeness and accuracy to ensure only patients that received counseling services under the Demonstration Grant are included; (2) Maintain documentation supporting how the program income was used to further eligible project objectives; and (3) Ensure review of the information in steps (1) and (2) prior to requesting reimbursement under the Demonstration Grant. We also recommend that Flushing contact HHS to inform them of the noncompliance with the program income requirement during the year ended December 31, 2022. Management?s Views and Corrective Action Plan Management?s Views and Corrective Action Plan is included at the end of this report.

Corrective Action Plan

2022-02: Significant Deficiency ? Program income compliance and controls Federal Agency: Department of Health and Human Services Program: Certified Community Behavioral Health Clinic Demonstration Grant Assistance Listing Number: 93.829 Management agrees that during the year ended December 31, 2022, Flushing did not have a formal control in place to identify, monitor and report program income collected from providing mental health counseling services to patients under the grant. Management has contacted The Department of Health and Human Services to inform them of this finding. Medisys Health Network, which includes Jamaica Hospital and Flushing, is the recipient of various federal grants, including another grant with program income requirements which was identified as a result of management?s review of the awards and for which controls have been designed and implemented to ensure compliance with the requirement. We believe our oversight of this compliance requirement was an isolated situation because the NoA only included one brief sentence regarding program income. Flushing will implement the following process to formalize controls related to the program income compliance requirement for the grant. 1) Management will review monthly charge/income reports for each clinician hired under the grant to keep track of the program income related to the grant. Management has started reviewing the program revenue and will set up quarterly reviews with the program director. 2) Management will keep track of all program income related to the grant and compare the income to the current expenses, and retain documentation supporting how the program income was used to further eligible project objectives prior to requesting reimbursement from the agency under the grant. 3) These controls and procedures will be implemented by the end of the 3rd quarter of 2023. Management responsible for corrective action plan: Gina Aharonoff, Program Director (gaharono@jhmc.org) Manzar Sassani, Vice President of Finance (msassani@jhmc.org)

Categories

Questioned Costs Cash Management Significant Deficiency Program Income

Other Findings in this Audit

Programs in Audit

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