Brookwood Pines Hospital

Goodfellow & Perkins gained a new client, Brookwood Pines Hospital (BPH), a private, not-for-profit hospital. The fiscal year-end for Brookwood Pines is June 30. You are performing the audit for the 2023 fiscal year-end.

The healthcare industry can be very complicated, especially in the area of billing for services provided. BPH contracts with private physician groups who use the hospital facilities, equipment, and nursing staff to treat patients. The physicians in the private group are not employees of the hospital; they are simply using the hospital facilities to treat patients. For example, a group of urologists have their own practice, separate from the hospital, where they treat patients. If one of the patients needs a surgical procedure that must be done at a hospital, then the attending urologist will approve the paperwork required to admit the patient to BPH. BPH offers inducements to the urologists so they will refer patients to BPH rather than a competing hospital. One of the inducements BPH offers is free office space in the hospital for the doctors to use when they are treating patients in the hospital.

After the doctor and hospital services are provided to the patient, the patient and/or the patient's insurance company is billed. The doctor will bill for the services he or she provided, and the hospital will bill for the use of hospital facilities and staff. Doctors and hospitals bill using a coding system that is standardized across the healthcare industry and consists of three main code sets: ICD, CPT, and HCPCS. Using a coding system is more efficient and data-friendly compared to writing a narrative about the procedures performed. However, the coding system is very complex, with thousands of different codes for medical procedures and diagnoses. To complicate matters even more, for patients who are covered by government-sponsored Medicare or Medicaid, doctors and hospitals must adhere to complicated government regulations surrounding billings to Medicare and Medicaid.

As healthcare costs continue to rise each year, BPH administrators struggle to maintain consistent profitability. They look for ways to keep costs low and also to collect from patients and insurance companies as quickly as possible. In addition, BPH must have a strong risk management team to handle unique situations that may occur in hospitals such as malpractice lawsuits and periodic inspections by the state department of health and hospitals. Negative publicity for BPH could lead to decreased revenues if physicians decide to contract with a competing hospital.

You are completing the planning of the audit of accounts payable and payments system. A prenumbered voucher is used to record all payables. An IT application control performs the following procedures:

• The vendor details, item numbers, quantities, and prices on the voucher are matched to information on the supplier's invoice and the appropriate receiving report.

• The vendor details, item numbers, and quantities on the voucher are matched to information on an authorized purchase order.

• Manual follow-up procedures are performed daily by a data control group. Any exceptions are corrected within 24 hours.

Required

Given the information provided in the case regarding internal controls in the purchasing process:

a.) Evaluate the quality of internal controls for each assertion related to purchase transactions.

b.) For assertions where internal controls are determined to be strong, suggest appropriate tests of controls to test the assertion.

c.) For assertions where internal controls are weak, prepare a recommendation to management identifying the weakness, the risk of misstatement associated with the weakness, and a recommended control to correct the weaknesses.