«CALL TO ORDER Ms. Emily A. Youssouf Adoption of Minutes December 4, 2014 Ms. Emily A. Youssouf • INFORMATION ITEMS Audits Update Mr. Chris A. ...»
AUDIT COMMITTEE February 19, 2015
125 Worth Street,
5th Floor Board Room
CALL TO ORDER Ms. Emily A. Youssouf
Adoption of Minutes December 4, 2014 Ms. Emily A. Youssouf
Audits Update Mr. Chris A. Telano
Compliance Update Mr. Wayne McNulty •
ADJOURNMENTNew York City Health and Hospitals Corporation
MINUTESAUDIT COMMITTEE MEETING DATE: December 4, 2014 TIME: 10:00 AM
COMMITTEE MEMBERSJosephine Bolus, RN
OTHER BOARD MEMBERSMark Page
A meeting of the Audit Committee was held on Thursday, December 4, 2014. The meeting was called to order at 10:11 A.M. by Mrs. Bolus, Committee Member. Mrs. Bolus stated that Mr. Mark Page, Board Member, is here in a voting capacity. Mrs. Bolus then asked for a motion to adopt the minutes of the Audit Committee held on October 2, 2014 and the minutes for a Special Audit Committee meeting held on November 12, 2014. A motion was made and seconded with all in favor. An additional motion was made and seconded to hold an Executive Session of the Audit Committee.
Mrs. Bolus then turned the floor over to KPMG personnel and asked them to introduce themselves. Ms. Maria Tiso introduced herself as the Engagement Partner and she introduced Joseph Bukzin, Senior Manager. She stated that they were there to discuss the 2014 management letter; they will go through some of the key highlights rather than going through a 50-page document.
Ms. Tiso began with page one which is the opinion. The opinion talks about the review of internal controls and that there were no material weaknesses or significant deficiencies identified in the comments in the management letter.
These comments are more a matter of the internal controls improvements or best practices. There was nothing noted that was a material weakness or a significant deficiency. The letter is broken into five sections, which is broken out in the matrix of observations, which gives a snapshot of where the findings fell under. We also have comments relating to Corporate Office, Information Technology, site visits and also added a section about prior-year comments that were cleared and then lastly the industry comments. These industry comments are comments that we have been including in many healthcare organizations and talks about items and issues that are going on in the healthcare industry globally.
Ms. Tiso continued by stating that page three is the matrix of observations. Many of our comments relate to Corporate Office and then some of the comments do relate to some of the networks. Page four begins with our observations; Ms.
Tiso then turned the presentation over to Mr. Bukzin.
Mr. Bukzin saluted everyone and said picking up on page four, starting with some of the corporate observations. The first one relates to the External Financial Reporting Package Review. As part of the bond obligations, the organization is required to file their financial statement publicly online on a quarterly basis, and the recommendation is to make sure that the financial statement gets published quarterly; it is also reviewed and compared against what was approved during the Finance Committee and Board-level meetings. Management agrees to implement the control around that process. The next one is Accrued Expenses – with tight regulatory requirements and in the spirit of quarterly reporting, it makes sense as a best practice to make sure that the accruals are adjusted more frequently than annually, perhaps on a quarterly basis. Management has agreed to revisit the process for accruals to ensure that they are.
Mr. Page asked if it is realistic to try to do that on quarterly basis?
Mr. Weinman answered stating that currently in Central Office we take care of most of the quarterly adjustments because we must report quarterly expenses coming out of Central Office, but we are talking from the facility standpoint. Most of what they purchase is OTPS, supplies and services; we think it is realistic that we could accomplish this on a quarterly basis.
Mr. Page then asked if they are also reporting on the revenue side? To which Mr. Weinman responded yes.
Mr. Page asked if your accruals on the revenue side were working? Ms. Zurack answered that we do that now quarterly. Mr. Weinman added that a very large part of the audit’s concentration is on the revenue, and we do that quarterly and is reviewed extensively by the end of the audit. Part of their opinion is based on the fact that we recorded appropriately.
Ms. Zurack stated that if a facility is following our standard operating procedures, when a good is received, it should be logged into the OTPS system, so that accruals should be almost automatic. It is about services, and there is not much of that going on.
Mr. Bukzin continued to page five and stated that the next comment is a repeat from the prior year regarding affiliation contracts, and there is a whole host of bullets that were carried over from the prior year management letter.
Management has continued to work towards and implement policies and procedures to remediate and address these bullets. It is not fully remediated at this point, so we felt it was necessary to continue to carry it forward.
Mrs. Bolus asked about the incomplete human resources files where they do not have the letters from people who are exiting HHC.
Ms. Tiso said that this comment was the same that was in last year’s management letter – it is identical.
Mrs. Bolus asked if they had been more diligent in getting this letters?
Ms. Tiso answered that there have been some improvements, but not enough for it to be taken out of the management letter. The Corporation is working towards it, but it is taking a bit longer to get the comment remediated.
Mr. Bukzin added that there is a 2014 observation that falls under the category of “Affiliation Contracts” and we just wanted to highlight that as something new that falls under this heading. This is the internal audit review of the PAGNY corporate expenses that did not occur but it is required to occur. It is our understanding that management is in the process of working with the PAGNY management team to make sure that the internal audit does occur on a timely basis.
Mr. Page referred back to the documentation of people coming in and out, and asked if we are dependent on the affiliate to produce that information, or is that something we do internally for individuals that we pick up through the affiliation?
Mr. Nelson Conde was asked to approach the table by Mr. Martin. Mr. Conde responded that we are dependent on the affiliate to produce the documentation for us.
Mrs. Bolus stated that she has come across this in two years and asked why it cannot be cleared up and why is it still such a problem that it has to appear in the letter.
Ms. Zurack asked if this is KPMG’s direct finding? To which Ms. Tiso replied no, this is a comment that was issued in last year’s management letter, and it was a sample of affiliates, so it is not just one affiliate. It was a sample that we have taken from last year.
Ms. Zurack then asked what audit work did they do to check to see whether it was cleared.
Mr. Bukzin replied that we work with Mr. Weinman and his team to understand the status of the prior-year comments.
Ms. Zurack asked what did that work consist of? Mr. Weinman answered that generally, in response to a prior year’s audit comments, we give an opportunity for those comments to provide some type of support of remediation for that comment. If we do not get any type of proof of remediation, it still appears on the letter. We still have an opportunity to clear this for next year, but we do not have any support yet.
Ms. Zurack asked in this particular comment, who did we solicit that opportunity to show the remediation, to the affiliates or to ourselves?
Mr. Weinman answered to us. Ms. Zurack then asked to which office? Mr. Weinman responded generally to the Office of Professional Services & Affiliations.
Mr. Martin asked who is responsible? Ms. Zurack stated that she thinks that Mr. Weinman is saying is that probably someone on my team went through all the comments and sent a note to someone on each area of responsibility to say, “If you cleared this up, show us,” and OPSA would have gotten this one, not the facilities themselves. Maybe Mr.
Conde has to do some homework and let us know what happened, but whatever you guys provided is not addressed.
Mrs. Bolus said that we have a lot vacancies, sometimes three to four month vacancies, and what offers are being made, then when people resign; we need to know why they are resigning.
Ms. Zurack suggested that we should come back to this, because it is such a long comment that probably Mr. Conde and his team had so much to answer that this one item may be on memory. We are still talking a lot about the recalcs and everything else and maybe this one had not been highlighted as important.
Mr. Bukzin continued with the next comment on page eight entitled Capitalization of Software Costs. This is an accounting treatment relating to computer software upgrades, major electronic medical records systems and costs incurred that may or may not meet the definition of expense versus capitalization. There were about $5 million of expenses that were reported as expense that should have been capitalized. Since the electronic medical records system is a significant ongoing project with a lot of expenses attached to it, we felt it was appropriate to recommend review of this area as well as working with the IT Department to capture payroll-related expenses as well.
Mr. Bukzin stated that the next comment titled Centralization also falls under the category of a best practice of revisiting certain functions that currently are not centralized. We do acknowledge that management has started centralizing certain functions, such as the procurement function, but perhaps there are also other areas for opportunity, and that opportunity could enhance controls, reduce costs to the organization, and promote cross-functionalization amongst employees.