Cincinnati Health Network, Inc.Non-Profit

Finding 2025-001: Cash Management (Material Weakness) Federal Program: Grants to Provide Outpatient Early Intervention Services with Respect to HIV Disease (Ryan White Part C). [93.918] Federal Agency: U.S. Department of Health and Human Services (HHS) Criteria: Effective internal controls require an entity to have a financial management system that provides accurate, current, and complete disclosure of the financial results of a federally assisted project (2 CFR § 200.302). Drawdown requests must be based on actual incurred expenditures and be properly reviewed for accuracy before submission to minimize the time between draw and disbursement (2 CFR § 200.305). Additionally, the entity must maintain records that adequately identify the source and application of funds for all federally assisted activities (2 CFR § 200.333). Condition: During our audit of the financial management system and cash management practices for the Ryan White Federal Program, we identified the following deficiencies: Transposed Drawdown Amount: A drawdown request submitted to the PMS system for the Ryan White Program had the requested amount transposed with the amount of another federal program. This resulted in an over-request of a material amount on the Ryan White Program. Duplicate Invoice Reimbursement: An invoice was requested and received for reimbursement on a prior drawdown and was subsequently included again in a draw after year-end, resulting in a duplicate reimbursement. Incomplete Expenditure Tracking: The entity did not have a complete system for tracking all expenditures eligible for reimbursement. The drawdown process was limited to cash disbursement and payroll transactions and excluded expenditures incurred and recorded by journal entries. This resulted in the entity having unreimbursed expenditures that could have offset the over-requests noted above. Questioned Costs: $252,567 The questioned costs consist of the material amount over-requested in the transposed drawdown and the duplicate reimbursement of the previously paid invoice. A detailed breakdown is as follows: Over-requested amount due to transposed data: $150,516 Duplicate reimbursement for invoice submitted twice: $102,051 Cause: The organization's internal controls over the cash management and drawdown request process were inadequate. Specifically, there was a lack of a formal review and approval process to verify the accuracy and completeness of drawdown requests before they were submitted. Effect: The deficiencies in internal control led to material noncompliance with federal regulations related to financial management and cash management. This resulted in the entity holding federal funds in excess of immediate needs, which is a violation of the terms and conditions of the federal award. The inadequate financial management system also prevented the entity from accurately tracking and requesting all eligible expenditures, which could have helped offset the over-draws. Context: This is a systemic finding. Repeat Finding: No. This is the first time this specific finding has been identified. Recommendation: The entity should implement robust internal controls to ensure all drawdown requests are reviewed and approved by a second person with authority. A reconciliation of expenditures to the general ledger should be performed before each drawdown to ensure all eligible costs are included and that no duplicate requests are made. The entity’s cash management policies and procedures should be updated to address these deficiencies and ensure compliance with federal requirements. Management Response: The organization acknowledges and we are committed to remediation. To correct the deficiency, we are implementing a plan focused on establishing a review and approval process for all drawdown requests and revising our policies to ensure that all eligible incurred expenditures are properly captured and reconciled, thereby assuring strict compliance with federal cash management regulations and preventing federal funds from exceeding our immediate needs.

Finding 2025-002: Competitive Proposal Process for Dental Van Procurement (Significant Deficiency) Federal Program: FIP [93.526] Federal Agency: U.S. Department of Health and Human Services (HHS) Criteria: Federal regulations under the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (2 CFR Part 200), specifically 2 CFR § 200.319(b) and § 200.320(b), require that all procurement transactions be conducted in a manner providing full and open competition. For a competitive proposal process, the organization must publicly advertise the procurement and include a clear and accurate description of the technical requirements and specifications for the goods or services to be procured. Furthermore, 2 CFR § 200.320(b)(2)(i) requires that proposals be evaluated and a selection made based on established evaluation criteria. These criteria must be clearly stated in the solicitation and must be used as the basis for the selection, ensuring that price is a factor but not the only one. Condition: The organization intended to use a competitive proposal process to procure a van. However, it failed to publicly advertise the request for proposals, limiting the pool of potential vendors to only those known to the organization. Additionally, the request for proposals did not include a complete and accurate list of specifications, nor did it include the evaluation and selection criteria that would be used to assess the proposals. While the organization did obtain three proposals and documented its rationale for selecting a vendor that was not the lowest bidder, the overall process did not meet the standards for full and open competition required by federal regulations. Questioned Costs: None Cause: The organization lacked a clear understanding of the specific requirements for a federal competitive proposal process. There were no written procedures or internal controls in place to ensure all required documentation and steps were followed. This oversight, combined with an over-reliance on informal practices, contributed to the noncompliance. Effect: The non-compliant procurement process increases the risk that the organization paid more than was necessary for the vehicle, which is an inefficient use of federal funds. Context: This procurement was for a significant asset for the program. While the organization has made an attempt to solicit proposals, the process was fundamentally flawed from the outset due to the lack of public advertising, incomplete specifications, and missing evaluation criteria. This is the first time the organization has procured a van with these funds, and the error was an oversight rather than an intentional act of noncompliance. Repeat Finding: No. This is the first time this specific finding has been identified. Recommendation: The organization should immediately develop and implement a comprehensive procurement policy and procedures manual that fully aligns with 2 CFR Part 200. This manual should provide a detailed checklist for all procurement methods, including specific requirements for public advertising, developing clear specifications, and documenting the full evaluation process based on a set of pre-established criteria. Mandatory training on federal procurement regulations should be provided to all staff involved in federal awards management and procurement to ensure they understand the importance of compliance. Management Response: The organization acknowledges the finding. To address this, we are committing to develop and implement a comprehensive procurement policy and procedures manual that strictly aligns with requirements within the Uniform Guidance. This manual will include detailed checklists for all procurement methods, covering public advertising, clear specification development, and the use of pre-established, documented evaluation criteria, followed by mandatory training for all staff involved in procurement.

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