Are auditors allowed to access medical records?

During a recent Falmouth class, someone raised a question about allowing auditors access to medical-related records when they are conducting single audits. The main concern was how allowing the auditor access to medical records would square with HIPAA Act privacy requirements.

 When testing grants or contracts for A-133 Major Program compliance in the Health and Social Services functions, a level of access is required.  In the course of testing, an auditor usually encounters information considered confidential under HIPAA. According to John Friel CPA and Falmouth consultant, who conducts single audits for tribal organizations, auditors are required to sign a HIPAA disclosure agreement when they are going to be reviewing health records. In addition, they are bound by the Code of Conduct of the American Institute of Certified Public Accountant to keep all records, particularly health records, locked in a secure place.  

So an auditor would have access to health records, but only to certify compliance to federal regulations.

California Faulty in ICWA Notifications to Tribes

California courts hear more Indian Child Welfare Act cases than any other state in the country, because the state social workers are not complying with the ICWA notification provision, according to a study presented last October at the American Indian Identity Conference held at Michigan State University. The study was the topic of a recent blog post on Turtle Talk. The author of the study, Kathryn Fort, found that California is doing a poor job of notifying Indian tribes that Indian children have entered the court system. Among other things, the study suggests that social workers do not have a sufficient understanding of ICWA or tribal membership requirements.  Also noted in the post was another paper by Matthew Fletcher on the legislative history of the Indian Child Welfare Act. 

Robideaux Indian Affairs Hearing Available

Yesterday's Senate Committee on Indian Affairs confirmation hearing for Indian Health Service nominee Dr. Yvette Roubideaux is available for viewing on the committee's website.

GOP Blocks Vote on Sebelius for HHS

Saying they needed more time to consider her record, Senate Republicans Thursday refused to allow confirmation vote on Gov. Kathleen Sebelius (D-Kansas), President Obama’s nominee to head the Department of Health and Human Services. Read more in the Washington Post.

Law and Order for Western Michigan Tribes

Interlochen Public Radio recently produced a report on how diligent federal prosecutions of crimes committed on Indian lands the Western District of Michigan has improved law and order for the 11 Indian nations there. Assistant United States Attorney Jeff J. Davis is the liaison between the United States Attorney's Office and the eleven federally recognized Tribes in the Western District of Michigan. Davis, who is a member of the Turtle Mountain Band of Chippewa, is interviewed in the report about the importance of working with tribal governments and tribal law enforcement.

FLSA Applies to Indian-Owned Smoke Shop on Reservation

As reported at Turtle Talk, the U.S. 9th Circuit Court of Appeals has ruled that the Fair Labor Standards Act applies to Indian-owned businesses operating on Indian reservations and that the Secretary of Labor has the right to inspect the books of such businesses. 

The case, Solis v. Matheson, centers around a smoke shop owned by a member of the Puyallap Tribe and operated on the Puyallap Reservation in Washington. The Secretary of Labor subpoenaed the books of the smoke shop and determined that the owners failed to pay overtime wages to its employees, as required by the FLSA. The district court agreed. The 9th Circuit affirmed the decision on appeal.

Are Changes Ahead for the Single Audit Process?

State, local and tribal governments have long been subject to the Single Audit Act, which requires that entities expending more than $500,000 in federal funds in a year be subject to an annual audit to determine that the funds were spent properly. Now a recent report by the Government Accountability Office questions the effectiveness of those audits. 

In a report issued last month, the GAO noted that little spenders, those spending between $500,000 and $2 million, are getting a lot more attention from federal agencies than big spenders, those expending $50 million or more. The report points out that 2.6 percent of the audits conducted covered more than 85 percent of the federal money spent by non-profits and state, local and tribal governments. Conversely, more than 50 percent of the audits conducted covered just 2 percent of the federal award expenditures.    

The law, as it is currently written, imposes the same audit standards on a non profit spending $600,000 in federal funds as it does on a city that spends $23 million in federal funds. The GAO questions whether the process of implementing the Single Audit Act is placing an unfair burden on the smaller entities, while it doesn’t focus enough attention on the larger ones.

 "Without a mechanism in place to monitor on an ongoing basis how the single audit process is implemented government-wide, OMB and federal stakeholders are unable to measure the efficiency and effectiveness of this process, as well as its usefulness as an accountability tool over federal grant awards,” the report says. “The variations we found on how federal agencies we reviewed perform key functions of the single audit process demonstrate the need to assess whether federal agencies carry out their single audit responsibilities in an efficient and effective manner."

 This report could result in different audit standards for smaller entities. What the standards might be is unknown however auditors through their associations should be prepared to provide input into this process.

 Tribal governments that might benefit from relaxed federal standards would have the option as a government entity to adopt their own audit standards. The question is, would the cost associated with implementing these standards be an allowable indirect cost as the single audit fees now are. The GAO report did not discuss potential savings or if that was even a consideration, however it appears there would be a savings to those entities classified as small.