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Orange County Health Department <br />January 23, 2025 <br />Page 5 <br /> <br /> <br />Cost Report Preparation <br />While cost report preparation involves assembly of information in a financial statement format, that <br />information is solely for cost report purposes and should not be used for any other purpose. Our services <br />will be limited to presenting, in the form prescribed by the Centers for Medicare & Medicaid Services (CMS), <br />information that is the representation of management. Management will be responsible for posting any <br />accounting entries determined to be needed as part of the cost report preparation process. <br />Our engagement is not designed to prevent or detect and cannot be relied upon to prevent or detect fraud, <br />abusive acts, errors, and omissions including, but not limited to: <br /> Nonallowable costs that you have not identified or that are misclassified or combined in another <br />account <br /> Insufficient underlying documentation to support the information you have provided to us <br /> Billing errors including coding errors, billing for noncovered services, and improper bundling or <br />unbundling of charges <br /> Insufficient medical records documentation of physician orders, medical necessity of services, or <br />performance of services <br /> Inappropriate physician arrangements including payments for referrals or contracts that do not <br />comply with the laws commonly known as the “Stark” or “anti-kickback” laws <br /> Misstatements that might exist due to fraudulent financial reporting or misappropriation of assets <br /> Failure to comply with the Medicare and Medicaid conditions of participation <br /> Failure to comply with the Internal Revenue Code and related regulations <br /> Related-party costs that you have not disclosed to us <br />Cost reports are subject to review by administrative contractors and others with oversight responsibility. <br />Professional judgment is used in resolving questions where the cost report and reimbursement rules and <br />regulations are unclear. You understand that reviewers may choose to interpret rules and regulations in a <br />manner different than that reflected in the cost reports, and reviewers may propose adjustments to your <br />cost reports which could have an adverse effect on your cost report settlements. <br /> <br />Management acknowledges and understands their responsibility for the following: <br /> <br /> Providing data in a summarized concise manner so that Forvis Mazars does not incur significant <br />additional time manipulating information into a format usable for this engagement <br /> Overseeing these services by designating an individual possessing suitable skill, knowledge, <br />and/or experience to oversee the engagement <br /> Evaluating the adequacy and results of the services performed and accepting responsibility for the <br />results of such services <br /> Establishing and maintaining effective internal control over financial reporting <br /> Setting the proper tone <br /> Creating and maintaining a culture of honesty and high ethical standards <br /> Establishing appropriate controls to prevent, deter, and detect fraud, illegal acts, and <br />noncompliance with laws and regulations <br /> Submission of the cost report and any related materials to the state of North Carolina is your <br />responsibility. You will review the information we submit and will be solely responsible for its <br />accuracy and completeness. You will be responsible for signing the certification page of the <br />Medicare cost report. If you identify any errors or discrepancies in the submissions, it is your <br />responsibility to notify us to discuss resolution options <br /> Notifying us timely and, as applicable, providing us copies of any correspondence received by <br />you from regulators regarding the cost report <br /> <br /> <br />Docusign Envelope ID: 183D8F77-022B-48BA-9D7A-59C5C1C4FC1A