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Capital grants and contributions can create complex accounting questions for nonprofits and nonprofit healthcare entities. Learn how US GAAP guidance, donor restrictions, capitalization policies, and project timing affect the accounting and financial statement presentation of capital funding and assets. 

The December 31, 2026 deadline for pre-approved 403(b) plan restatements may seem far off, but waiting could create vendor delays and compliance risk. Learn what plan sponsors should review, adopt, retain, and communicate now to stay on track.

Nonprofits may not need to change Form 990 reporting yet, but new transparency proposals signal more scrutiny ahead. Learn what tax-exempt organizations should know about proposed legislation and why strong documentation remains important.

Time and effort reporting is more than a routine administrative task—it’s a key control to ensure that payrolls charged to federally funded grants are allowable and properly supported. Because it is a high-risk area for grantees—and a frequent audit finding for HRSA grantees—strong documentation is critical to reducing compliance exposure and administrative burden. This article breaks down what time and effort reporting is, why the urgency has increased, and what health centers can do to strengthen practices and lower risks. 

In today’s increasingly digital environment, cybersecurity has become a critical concern for nonprofit (NFP) organizations. While many NFPs operate with smaller teams and tight budgets, they still handle sensitive information—donor records, payment data, client demographics, and sometimes even health‑related or financial assistance files. Unfortunately, cybercriminals recognize this and often view NFPs as soft targets with valuable data. Because community trust is so important, a cybersecurity incident can create financial and reputational hurdles for an organization. The good news, however, is that strong cybersecurity foundations do not always require major capital investments. With strategic planning and a focus on essential controls, even the most resource‑constrained organizations can significantly reduce cyber risk. 

A new federal executive order aimed at eliminating fraud, waste, and abuse signals a clear shift for healthcare and not-for-profit organizations that receive federal funds. While oversight of federal programs is nothing new, this order formalizes a cross-agency task force and raises expectations around documentation, internal controls, and accountability, particularly for organizations that participate in Medicaid, Medicare, and federal grant and assistance programs.

Beginning with calendar year 2026, public housing agencies (PHAs) will be required to submit an annual Federal Financial Report (SF-425) for each operating subsidy grant. Reporting will continue annually until all funds are fully expended or returned to HUD. These changes reflect HUD’s increased focus on transparency, grant life cycle oversight, and compliance monitoring.

To quote George R. R. Martin, “Different roads sometimes lead to the same castle.” The same can be said for Schedule A. When it comes to qualifying as a public charity, the IRS offers more than one path forward. In Part I of this series, we explored the Schedule A Part II public support test—a common route for donor‑supported organizations. In this second installment, we turn to the Schedule A Part III test, an alternative approach designed for organizations that operate under a fee‑for‑service or program‑revenue model. While the tests are different, both can ultimately lead to the same destination: public charity status. 

This is the first in a two-part series that provides a detailed examination of Form 990, Schedule A, offering practical guidance to the many organizations responsible for its complete and accurate preparation. This article focuses on organizations that qualify under Part I, Line 7 – 509(a)(1) – and the steps required to substantiate this classification through the Part II public support test. 

Charitable organizations play a vital role in addressing social issues, supporting communities, and promoting public welfare. As part of their mission, these organizations often make direct charitable expenditures to fund projects, provide services, and support individuals in need. However, with the privilege of tax-exempt status comes the responsibility to ensure that funds are used appropriately and in compliance with regulatory requirements. One crucial aspect of this compliance is expenditure responsibility, a concept that ensures charitable resources are used for their intended purposes. 

The Governmental Accounting Standards Board (GASB) issued Statement No. 105, Subsequent Events to enhance the transparency, consistency, and value of financial reporting related to events that occur after the financial statement date, but before the financial statements are issued. The statement realigns existing guidance by clearly describing the subsequent events' time frame, distinguishing between recognized and non-recognized subsequent events, and providing specific disclosure requirements. 

Rolling out new software isn’t just clicking “Install” and calling it a day. It’s more like planning a wedding. There’s the venue (servers), the guests (users), and yes, the unexpected costs that show up like distant relatives. In today’s digital-first world, implementing software is a strategic investment that can boost efficiency, strengthen compliance, and support long-term growth. However, the true cost goes beyond the sticker price on that shiny new platform. For nonprofits operating on limited budgets, careful planning is essential to avoiding hidden costs when making a technology upgrade. 

The affordable housing landscape in the United States is on the cusp of significant change with the introduction of the Renewing Opportunity in the American Dream (ROAD) to Housing Act of 2025. For nonprofit organizations operating in the affordable housing sector, this proposed legislation brings both new opportunities and important considerations. Here’s what you need to know. 

Liquidity is the lifeline of any nonprofit organization. Strong liquidity ensures uninterrupted programs, financial stability, and the flexibility to respond to unexpected challenges. This article shares practical steps to monitor and manage liquidity effectively, including setting clear policies, tracking cash flow, using key financial ratios, managing reserves, and leveraging technology. By following these best practices, organizations can maintain resilience, build trust with stakeholders, and stay focused on their mission—even during uncertain times.

Private foundations are vital players in the philanthropic landscape, channeling resources toward charitable, educational, and scientific causes. However, to maintain their tax-exempt status and avoid excise taxes, these organizations must comply with strict IRS rules—particularly those governing qualifying distributions. In the second installment of our trilogy, we will follow the McQueen Family Foundation to determine their qualifying distributions. As a non-operating foundation, this is a crucial step in their annual compliance requirements. 

The Minimum Investment Return (MIR) is a critical component for all private foundations. It is a standardized calculation based primarily on the value of the foundation’s investment (i.e., non-charitable use) assets to ensure that endowments are put to charitable use rather than accumulating excessive wealth with little to no public benefit. By adhering to IRS guidelines and maintaining diligent records, foundations not only avoid costly penalties but also contribute meaningfully to the communities and causes they support. 

A new Executive Order issued by President Donald Trump on August 7, 2025, brings major changes to how federal agencies handle discretionary grants. Titled "Improving Oversight of Federal Grantmaking," the changes in this Order introduce more political oversight, tighter controls on how funds are used, and new compliance rules that will directly affect organizations receiving federal funding. 

Capital campaigns can be game changers for nonprofits, enabling bold investments in infrastructure, programs, and long-term growth. Whether you're building a new facility, expanding services, or upgrading technology, a capital campaign aligns fundraising with your strategic vision. 

Signed into law by President Trump on July 4, 2025, the One Big Beautiful Bill Act (OBBBA) marks a significant step forward in addressing America’s growing need for affordable housing. With the demand for low-cost units far outpacing supply nationwide, the legislation offers targeted solutions aimed at making development more feasible and sustainable.

As artificial intelligence (AI) becomes increasingly woven into nonprofit operations, boards are stepping into a new and critical role. Traditionally focused on mission oversight and fiscal responsibility, today's boards must also shape how AI is introduced, governed, and aligned with the organization’s values. Below are the seven most important actions a board can take to ensure responsible and strategic AI implementation. 

Credit, purchase, and debit cards each offer convenience for small-dollar purchases, but carry varying levels of risk. Strong internal controls are essential to prevent fraud, misuse, and compliance violations.

Nonprofit leaders must assess the risks and strategically position their organizations to adapt to changing funding landscapes. This article outlines key steps to help your organization proactively evaluate funding vulnerabilities, mitigate risks, and plan for sustainable operations. 

With default federal student loan collections now resumed by the Department of Education, higher education institutions and other effected nonprofits need a strategy to ensure compliance. 

Most nonprofits rely on federal and state government funds to fulfill their missions. With a federal funding freeze in the headlines, many clients are asking us how they can best prepare for a freeze and protect their organizations if funding is cut. Here are three steps you can take today to stay ahead. 

As the new year begins, your organization may be starting to plan for your next fundraising event. In addition to raising money for the organization, fundraising events are a wonderful way to build relationships within the community, raise awareness for a cause, and provide a meaningful experience to donors. Beyond the excitement and benefits of these events, there are important Form 990 reporting and compliance requirements that you must consider. Below are the most frequently asked questions we receive from our clients. We hope this helps you avoid some common pitfalls around fundraising events.

Is your nonprofit using a break-even bottom line as your ultimate budget goal? If so, you may be missing out on opportunities to strategically further your mission. By looking at your budget using a statement of financial position perspective, rather than just a profit and loss perspective, you can gain a more complete financial picture of your organization.

As organizations navigate the complexities ahead in 2025, economic uncertainty presents both challenges and opportunities. Organizations must strategically address financial stability, donor engagement, federal compliance requirements, and workforce management to sustain their missions. This article dives into five critical finance trends and explores how nonprofits can effectively adapt.

The housing industry is subject to ongoing regulatory changes that are critical to their operations. Recently, we shared changes impacting compliance for multifamily housing, but that's just one example; all facets of the industry are subject to ongoing changes to compliance.

If it’s been a while since your nonprofit organization last conducted a review of its governing documents and policies, worry not, you’re not alone! This article will highlight a few of the most critical documents applicable to nonprofits to ensure you remain in compliance and good standing.

The United States Department of Housing and Urban Development (HUD) signed the Housing Opportunity through Modernization Act (HOTMA) into law on July 29, 2016. For multifamily housing owners, HOTMA went into effect on January 1, 2024, and owners are expected to be fully compliant by January 1, 2025.

Not-for-profit board members need to wear many hats for the organization they serve. Every board member begins their term with a different set of skills, often chosen specifically for those unique abilities. As board members, we often assist the organization in raising money and as such, it is important for all members of the board to be fluent in the language of fundraising. Here are some basic definitions you need to know, and the differences between them

Of all the changes that came with the sweeping Tax Cuts and Jobs Act (TCJA) in late 2017, none has prompted as big a response from our clients as the changes TCJA makes to the qualified parking deduction.

Good fundraising and good accounting do not always seamlessly align. While they all feed the same mission, fundraisers work to meet revenue goals while accountants focus on recording transactions in compliance with accounting standards. 

As 2018 is about to come to a close, organizations with fiscal year ends after December 15, 2018, are poised to start implementing the new not-for-profit reporting standard. Here are three areas to address before the close of the fiscal year to set your organization up for a smooth and successful transition, and keep in compliance:

With the wind down of the Federal Perkins Loan Program and announcement that the Federal Capital Contribution (FCC) (the federal funds contributed to the loan program over time) will begin to be repaid, higher education institutions must now decide how to handle these outstanding loans.

Last week, in addition to The Eagles Greatest Hits (1971-1975) album becoming the highest selling album of all time, overtaking Michael Jackson’s Thriller, the IRS issued Notice 2018-67—its first formal guidance on Internal Revenue Code Section 512(a)(6).

Over the course of its day-to-day operations, every organization acquires, stores, and transmits Protected Health Information (PHI), including names, email addresses, phone numbers, account numbers, and social security numbers.

Recently the Governmental Accounting Standards Board (GASB) finished its Governmental Accounting Research System (GARS), a full codification of governmental accounting standards.

As we begin the second year of Uniform Guidance, here’s what we’ve learned from year one, and some strategies you can use to approach various challenges, all told from a runner's point of view.

When it comes to offering non-qualified deferred compensation to executives of not-for-profit organizations, there aren’t many options.

With the implementation of GASB 72 now in full force, GASB organizations are hard at work drafting their new fair value disclosures. The addition of a fair value hierarchy table in the footnotes will add a bit more thickness to a likely already hefty financial package. 

Why it can happen to you and how to protect yourself. We’ve all seen the headlines. Stories about not-for-profit fraud have been popping up in the news, and the statistics confirm what you might have suspected: fraud in the not-for-profit sector is on the rise.

For a more in-depth discussion of these topics, download the comprehensive guide at the bottom of the article. 

Who this applies to: Professionals responsible for credit/risk, accounting, loan operations, and the C-suite at financial institutions.

Financial institutions have devoted significant time and resources to implementing the Current Expected Credit Losses (CECL) methodology. As CECL becomes part of the recurring financial reporting process, attention has shifted from implementation to ongoing governance, monitoring, and independent review. This article briefly summarizes our full guide on the differences between CECL model validation and CECL internal audit.  

What is a CECL model validation?

A CECL model validation is an independent assessment of the methodology and model used to estimate expected credit losses. Its principal objective is to determine whether the model is appropriate for its intended use, supported by sound reasoning, implemented correctly, and producing reasonable and reliable results. For a CECL estimate, validation may address conceptual soundness, model implementation and technical accuracy, and ongoing model performance.

What is a CECL internal audit?

A CECL internal audit evaluates the broader governance, risk management, compliance, and control framework surrounding the allowance estimate. While model validation asks whether the model is sound, internal audit asks whether the institution has an effective process for operating, reviewing, approving, and reporting the estimate. The review may include governance, data and reconciliation controls, access rights, management review controls, reporting, documentation, and remediation.

The most important difference: The questions being answered

The clearest way to distinguish between the two reviews is this: The model validator evaluates the substance of the estimate, while the internal auditor evaluates the process and controls by which the estimate is developed and reported.

Areas of overlap

Model validation and internal audit are distinct, but they are not completely separate. Both may review areas such as data quality and reconciliation, documentation, oversight, model changes, third-party service providers, model monitoring, findings and corrective actions, and policies and procedures. However, the two functions examine these areas through different lenses.

Why one review does not automatically replace the other

Relying only on model validation may leave governance and control risks unaddressed, while relying only on internal audit may miss flaws in the methodology, assumptions, calculations, or model performance. A sound oversight framework considers both model risk and control risk.

A practical illustration

Consider a community bank that applies a qualitative adjustment for worsening economic conditions. A model validation may identify that the adjustment is based on an economic indicator with little demonstrated relationship to the bank’s historical credit losses or creates a risk of double-counting. An internal audit may find that the allowance committee did not review and approve the adjustment as required. The example illustrates how a technically sound model can still have a deficient process, or a well-controlled process can still rely on an unsound model.

Independence and qualifications matter

Both CECL model validation and CECL internal audit should provide objective challenge to the CECL process. Reviewers should be independent from developing, operating, and approving the model, and they should have the appropriate expertise for the review. Institutions may use outside specialists when the necessary expertise or independence is unavailable internally, but management remains responsible for understanding the scope, reviewing the results, and addressing identified issues.

How frequently should each review occur?

Review frequency should be risk-based and reflect the institution’s size, complexity, portfolio composition, methodology, model risk, and prior findings. More frequent or extensive validation may be needed after significant model changes, data-quality issues, recurring findings, portfolio changes, or increased use of management judgment. Internal audit frequency should also reflect risk, and the validation cycle and audit plan should be coordinated to avoid duplication while addressing both model risk and control risk.

Questions management and directors should ask

Management, directors, and audit committee members should evaluate the institution’s CECL oversight framework by asking the right questions across three main areas: model validation, internal audit, and coordination between the two functions. Together, these categories help assess whether model risk and control risk are being addressed without unnecessary duplication.

Download the full guide to CECL model validation and internal audit: Understanding key differences

About the team

For institutions looking for the best value, with the right understanding of scope and combination of skills and expertise, BerryDunn’s dedicated financial services professionals can customize an approach to cover both. Learn more about our services or reach out to us through our Ask the Advisor form. For more insights and expertise, follow and connect with Susan Weber and David Stone on LinkedIn.

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CECL model validation and internal audit: Understanding key differences

Change is inevitable for local governments. Leadership transitions, rapid technological advances, workforce challenges, economic pressures, and shifting community needs can all affect how a locality operates. Yet a strong strategic plan should be able to withstand those changes.

Most local government strategic plans are designed to guide decision-making for three to five years. That time frame provides enough stability to establish meaningful direction while allowing flexibility as conditions change.

The challenge is knowing when change requires an adjustment to the plan, when it calls for a thoughtful refresh, and when it signals the need for an entirely new planning process. The answer depends less on any single event and more on whether the plan continues to reflect the community's priorities and provides a realistic framework for achieving them. Most organizations don't need to choose between rigidly following an outdated plan and starting from scratch. In many cases, the right path lies somewhere in between. To determine whether an organization will refresh an existing plan or create a new one, ongoing evaluation is critical.

Effective strategic planning is an ongoing, multiyear process supported by performance measurement and reporting. The most successful organizations regularly review progress, communicate results, and assess whether their objectives continue to reflect community needs. Effective metrics help leaders understand where progress is being made, where challenges remain, and whether actions are producing meaningful outcomes.

Organizations that regularly discuss progress, celebrate successes, and connect daily work to strategic priorities are more likely to keep their plans relevant and actionable over time. Many strategic plans fail not because they were poorly designed, but because they gradually disappear from regular conversations. With a strategic plan in place, implementation, and regular progress reporting, the question becomes how an organization should respond as circumstances evolve: stay the course, refresh the existing plan, or begin a new planning process.

When to stay the course

Not every change requires a strategic planning reset.

A well-developed strategic plan should be resilient enough to weather organizational and leadership changes. When the vision remains relevant and the community's priorities remain aligned with the plan, staying the course may be the best decision.

Leadership transitions are often among the first events that prompt questions about strategic direction as they may bring fresh perspectives. However, leadership turnover alone does not necessarily mean the community's vision has changed. In many cases, incoming leaders build on foundation of priorities that were developed through strong community and organizational engagement.

The same principle applies to election cycles. Changes within a governing body may introduce new ideas and areas of emphasis, but strategic plans should remain grounded in organization and community priorities. When the long-term aspirations that are actionable, remain unchanged, the existing plan continues to provide valuable guidance.

When an existing plan needs a refresh

While the vision may stay the same, the path to achieving it sometimes needs to change.

Communities experiencing changes in economic conditions, demographic shifts, development patterns, or changing resident expectations often find themselves facing challenges that were not fully anticipated when their plan was created. Leaders should evaluate the community's most pressing needs and determine what remains realistic and achievable. In many of these situations, a refresh of the plan is enough. By updating strategic priorities, performance measures, implementation strategies, and timelines, organizations can help ensure their plans remain relevant while preserving the broader vision that continues to resonate with the community.

When to start over

When leaders find themselves questioning not just how to achieve the vision but whether the vision itself is still relevant, it may be time to start fresh.

A new planning process may be appropriate when community priorities have fundamentally shifted, when major external changes have altered the community's future direction, or when the original vision no longer reflects the realities facing the organization. When the public, leadership, or staff expectations have created an entirely different environment from the one that existed when the plan was first developed, then it can affect an organization's ability to execute its strategy.

Rapid growth, major development, workforce shortages, retention issues, and cultural challenges can limit an organization's ability to carry out its strategy. Increasingly, local governments recognize that organizational health plays a direct role in community outcomes.

External factors can create similar challenges. State mandates, funding uncertainty, economic fluctuations, and policy changes can significantly affect available resources and organizational priorities. These pressures may not warrant a complete restart, but they often require leaders to revisit assumptions and identify new objectives for achieving established goals.

A new strategic planning process allows organizations to revisit foundational questions, gather fresh perspectives from stakeholders, and establish a new roadmap for the future. As the destination changes, revising the map and route may be necessary.

Key takeaways

  • A strong strategic plan should provide continuity and direction even when circumstances change.
  • Leadership transitions and election cycles do not automatically require a new strategic plan.
  • Refresh the plan when the vision remains relevant, but the approach needs to change.
  • Consider a new planning process when community priorities or the long-term vision has profoundly changed.
  • Regular evaluation, communication, and stakeholder engagement help keep plans relevant and actionable.
  • Strategic planning works best when it is treated as ongoing practice rather than a one-time event.

BerryDunn can help

Ultimately, strategic planning is not about producing a document. It is about creating a framework that helps organizations make informed decisions, adapt to change, and move consistently toward a shared vision. The strongest plans provide enough structure to guide decision-making while remaining flexible enough to evolve alongside the communities they serve.

A neutral facilitator can help organizations navigate these discussions. By gathering input, guiding conversations, and building consensus without advancing a particular agenda, a facilitator can help communities create strategic plans that are actionable, reflective of shared priorities, and achievable.

BerryDunn's local government consulting team helps communities develop strategic plans that align stakeholder priorities, create organizational focus, and support long-term success. Whether your organization needs leadership and staff development guidance, a wide-ranging planning process, a strategic plan refresh, organizational development support, or change management assistance, our experienced consultants can help you build a roadmap for the future and turn vision into action. Learn more about our services and team.

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Stay the Course, Refresh, or Restart Your Strategic Plan?

Who this applies to: Leaders responsible for finance/accounting, risk management, compliance, operations, IT, and the C-suite at financial institutions.

The FMS East Coast Regional Conference recently brought financial professionals together in Annapolis, Maryland, for three days of learning, discussion, and networking. During the conference, we presented “The Future of Finance: How AI and Tech Can Transform,” a session focused on how artificial intelligence and automation are changing finance, accounting, risk, and operations within financial institutions.  

Our central message was straightforward: Financial institutions will not gain a lasting advantage simply by using AI. As these tools become more widely adopted, differentiation will come from how effectively leaders redesign processes, develop their people, strengthen governance, and improve decision-making.

Finance is moving from reporting to anticipating

Historically, many finance functions have concentrated on periodic reporting, manual reconciliations, historical analysis, and responding to issues after they occur. The emerging model is more continuous and forward-looking, with real-time visibility, automated monitoring, predictive insight, and proactive decision support.  

AI may help financial institutions move routine processing into the background while allowing finance professionals to spend more time interpreting information, advising leadership, and applying judgment. Potential applications include:

  • Reconciliations
  • Regulatory change monitoring
  • Board-package preparation
  • Vendor due diligence
  • Internal audit planning
  • Fraud detection
  • Policy summarization
  • Credit and liquidity analytics

Importantly, AI is not the same as traditional automation, which generally follows predetermined rules and structured inputs. AI-enabled solutions can work with structured and unstructured information and may generate, predict, summarize, or recommend. Those capabilities create meaningful opportunities, but they also introduce new risks.

Innovation must be matched with governance

Institutions considering an AI use case should ask several questions at the outset:

  • Is the use case material?
  • Who owns it?
  • What data will the tool use?
  • Could the output affect customers or members?
  • What controls and monitoring will be necessary?
  • What vendor risks are involved?

AI may introduce risks involving data quality, inaccurate or fabricated outputs, bias, cybersecurity, privacy, model drift, third-party vendors, overreliance, and governance. Addressing these risks begins with clearly defined ownership, appropriate board visibility, acceptable-use policies, approved tools, data restrictions, training expectations, and a documented risk assessment for each use case.

One of the most important principles from the session was to treat AI-generated outputs as assertions requiring evidence, not as facts. Depending on the use case, controls may include human review, performance testing, segregation of duties, source citations, third-party validation, exception management, and evidence retention.

What the case studies revealed

During the session, attendees worked through scenarios involving AI-assisted reconciliations, AI-generated board reporting, and regulatory change monitoring.

In the reconciliation scenario, an overly broad matching threshold caused the system to clear items incorrectly. In the board-reporting scenario, AI-generated commentary relied on an outdated ALCO assumption. In the regulatory-monitoring scenario, an incomplete source library caused the institution to miss an important update.

Although the scenarios involved different processes, the lessons about what matters were consistent, including:

  • Data sources
  • Human review
  • Evidence
  • Ongoing monitoring

The objective is not to slow innovation. It is to make innovation reliable.

Start with the process, not the technology

Institutions do not need to transform everything at once. A practical approach is to:

  • Establish governance
  • Inventory current use cases
  • Assess risks
  • Design controls
  • Implement and communicate expectations
  • Monitor and adapt

Before selecting a tool, leaders should map the existing workflow, identify bottlenecks and manual workarounds, locate sources of error or delay, and clarify ownership. Opportunities can then be prioritized based on business impact, frequency, risk reduction, feasibility, and data availability. A controlled pilot allows the institution to measure results, refine controls, and scale intentionally. 

For many institutions, practical starting points may include reconciliations and exception management, board-package summarization, internal audit risk assessment, regulatory change monitoring, and vendor contract review. More complex applications, including fraud detection, credit risk analytics, CECL forecasting support, liquidity forecasting, and continuous auditing, may provide significant value but require more deliberate governance. Autonomous approvals or high-impact customer decisions without meaningful human review should be approached with particular caution.

The future finance function will not remove people from the process. Instead, technology will perform more routine tasks while people remain responsible for judgment, ownership, challenge, and decision-making. The institutions best positioned for that future will be those that start thoughtfully, build governance into their initiatives, and scale only after they understand both the benefits and the risks.

Key takeaways

  • Focus on process improvement, not just technology adoption, because long-term value from AI comes from better workflows, stronger governance, and more informed decision-making.
  • Shift finance teams from historical reporting toward real-time insights, predictive analysis, and proactive decision support.
  • Establish governance before scaling AI initiatives, including clear ownership, risk assessments, usage policies, data controls, and monitoring.
  • Verify AI-generated outputs through human review and supporting evidence, treating AI results as assertions that require validation rather than fact.

About BerryDunn

Have a question about how your financial institution can thoughtfully assess its processes, train team members, create effective internal controls, and improve decision-making to maximize the value of AI? Please don’t hesitate to reach out. Learn more about our team and services.

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The future of finance: AI at financial institutions

Who this applies to: Compliance officers, risk managers, revenue cycle, or healthcare administrators in a specialty, primary care, prenatal, or pediatric practice, or Federally Qualified Health Center (FQHC).

Has your medical practice seen an increase in missed appointments? Is your practice seeking to improve attendance for preventive care services? If yes, are you evaluating whether to establish a patient incentive program? Before you proceed, there are federal and state rules that should be analyzed to determine whether to initiate a pilot incentive program.

Patient inducements

A well-designed incentive program must be structured neither to give the appearance of nor be perceived as a patient inducement, based on US Office of the Inspector General (OIG) guidance. The OIG’s nominal value threshold applies exclusively to non-cash items; cash in any form is prohibited, as are general-purpose prepaid cards. Cash equivalents are items that patients can convert to cash and use for any purpose, such as gift cards from “big box” stores. The nominal value (“de minimis”) threshold sets the following limits for gifts:

A. Per-item limit: No single gift can have a retail value above $15. 

B. Annual aggregate limit: The total value of all gifts to the same patient in a calendar year cannot exceed $75. 

The Beneficiary Inducement Prohibition of the Civil Monetary Penalties (CMP) Law 

This law differs from the scope of the federal Anti-Kickback Statute (AKS). The Beneficiary Inducements CMP provides for the imposition of financial penalties (i.e., CMPs) against any person who offers or transfers remuneration to a Medicare or Medicaid program beneficiary if this might influence the beneficiary’s selection of a particular provider or practitioner. Remuneration means anything of value, whether cash, cash equivalents, or below-market-value goods or services.

Violations of the Beneficiary Inducement Prohibition can result in monetary penalties, plus three times the amount claimed from federal programs, and potential exclusion from participation in federal healthcare programs. 

To determine whether a patient incentive program violates the Beneficiary Inducement Prohibition, the National Association for Community Health Centers (NACHC) recommends that an organization ask the following three questions:

  1. Is your organization proposing to offer something of value (remuneration) to patients covered by Medicaid, the Children’s Health Insurance Program (CHIP), or Medicare?
  2. Is the remuneration likely to influence patients’ decisions to receive goods and services for your organization?
  3. Are the goods or services paid for by Medicaid, CHIP, or Medicare?

If the answer to all three questions is yes, then the patient incentive program violates the Beneficiary Inducement Prohibition unless it fits within an existing regulatory exception or safe harbor. 

What is a safe harbor?

The Department of Health and Human Services (HHS) has the authority to protect certain arrangements and payment practices (i.e., safe harbors) under the federal AKS. The safe harbor regulations are updated periodically to reflect changing business practices and technologies in the healthcare industry. These safe harbor provisions have been developed to limit the reach of the statute somewhat by permitting certain non-abusive arrangements (42 CFR 1001.952 Safe Harbors), while encouraging beneficial or innocuous arrangements.

One example is the Preventive Care Services Exception. The regulatory definition of preventive care, for purposes of this exception, means any service that: (1) is a prenatal service or a post-natal well-baby visit or is a specific clinical service described in the current US Preventive Services Task Force’s Guide to Clinical Preventive Services and (2) is reimbursable in whole or in part by a federal healthcare program.  

Clearly define your strategy

  • Define the population of patients eligible for the incentive pilot program, purpose, types of eligible visits (i.e., those scheduled based on the treatment plan) and the criteria for earning an incentive. Consider limiting eligibility for participation in an incentive pilot program to established patients, patients at a certain stage of a treatment plan, and/or a particular program.
  • Establish a documentation system to track the annual gift disbursement process.
  • Refrain from advertising a pilot attendance incentive program in new patient brochures or other marketing collateral to avoid the appearance of improper patient inducement or recruitment.
  • Document which safe harbor is relevant to your pilot program. If there are any questions about whether the proposed incentive program qualifies, your organization may seek an advisory opinion from the OIG.
  • Confirm that your incentive strategy does not violate any state rules prior to implementation.

Does your state have rules pertaining to incentives, lotteries, and raffles? Depending on your healthcare organization’s corporate status, the term “raffle” may be impermissible. For example, California only permits raffles to be conducted by nonprofit organizations; interested nonprofit organizations must apply for a raffle registration on an annual basis.

BerryDunn can help

Has your healthcare organization evaluated its strategies to promote patients’ attendance for well-child visits or prenatal care or other ambulatory services? If you already have an existing incentive program, have you evaluated it recently to determine whether or not it falls within a safe harbor? Are there any relevant state regulatory requirements that should be evaluated? 

Our healthcare compliance team can help. We incorporate deep, hands-on knowledge with industry best practices to help your organization manage compliance and revenue integrity risks. Learn more about our healthcare compliance consulting team and services.

Additional resources:

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Patient incentives: Balancing access, engagement, and compliance

Who this applies to: Chief Financial Officers, Chief Operating Officers, and Chief Compliance Officers at financial institutions.

Financial institutions rely heavily on third-party service providers to deliver critical technology, payment processing, online banking, compliance support, and other essential services. Recognizing the challenges many institutions face in managing these relationships, federal regulators recently issued a joint statement on core service providers and proposed updated third-party risk management guidance.

Focus on risk, not checklists

A central theme of the proposed guidance is that third-party risk management should be tailored to an institution's size, complexity, and risk profile. Regulators emphasize that not all vendor relationships present the same level of risk and that oversight should be tailored to the risks posed by each relationship. Instead, institutions are encouraged to focus resources on relationships that pose the greatest operational, financial, compliance, or customer impact. The regulators also reiterate that the guidance is principles-based rather than prescriptive, and that supervisory findings would be based on unsafe or unsound practices or legal violations rather than deviations from the guidance itself. 

The agencies also emphasize that effective risk management is about managing and understanding risk, not eliminating it entirely. Institutions may accept residual risks when doing so is consistent with their risk appetite and business objectives.

Regulators clarify their approach to core service providers

In a separate joint statement, regulators highlighted concerns about the market dynamics surrounding core service providers. Many financial institutions depend on a small number of large providers and often face challenges obtaining due diligence information, negotiating contracts, monitoring performance, or changing providers. 

To address these concerns, regulators indicated they will consider several factors when determining the level of supervisory attention directed toward core providers, including:

  • Transparency in sharing due diligence and performance information 
  • Timely disclosure of operational issues and cybersecurity incidents 
  • Use of clear service-level agreements 
  • Opaque pricing and billing practices 
  • Contract provisions that restrict an institution's ability to switch providers or integrate with other vendors 
  • Technology investments and operational resilience capabilities 

Accountability for core service providers may increase

Another noteworthy aspect of the regulators' joint statement is the reminder that, under certain circumstances, employees or agents of a core service provider may be considered Institution-Affiliated Parties (IAPs) of an institution. If an individual meets the statutory definition of an IAP, banking regulators may have authority to pursue enforcement actions directly against that individual for misconduct affecting a financial institution. The statement does not create new authority, but it signals regulators' willingness to consider existing enforcement tools when evaluating concerns involving third-party service providers. 

For institutions, this development could ultimately strengthen accountability within the vendor ecosystem. While institutions remain responsible for managing risks associated with outsourced activities, the statement suggests regulators are focused not only on how institutions oversee their core providers, but also on whether core providers and their personnel are meeting their own obligations to operate in a safe, sound, and transparent manner.

What financial institutions should do now

Financial institutions may wish to review their third-party risk management programs with an eye toward ensuring oversight efforts are aligned with actual risk levels. Institutions should also evaluate key core-provider contracts, service-level agreements, incident notification processes, and contingency plans for critical services.

The proposals suggest regulators are seeking to maintain a strong focus on material risks while encouraging a more tailored and efficient approach to third-party risk management. For institutions, that could mean more flexibility in managing lower-risk vendors while placing greater emphasis on understanding and managing relationships with critical service providers.

Bottom line for financial institutions

Regulators appear to be moving toward a more practical, risk-based supervisory framework that recognizes the realities institutions face when working with core providers and other third parties. Institutions should use this as an opportunity to ask whether their current vendor oversight is appropriately scaled to actual risk. In some cases, financial institutions may be applying the same level of documentation, review, and monitoring to lower-risk vendors as they do to critical service providers, creating unnecessary burden without meaningfully reducing risk. Vendors deemed to be low risk likely warrant a scaled-back oversight approach, allowing institutions to focus their oversight activities on vendors that truly represent the highest risk to the institution. Financial institutions that can demonstrate thoughtful risk assessment, proportional oversight, and sound governance should be well positioned under the evolving guidance and should use the guidance as an opportunity to level set their third-party risk management program.

Key takeaways

  • Align third-party oversight activities with the actual risk posed by each vendor relationship rather than applying the same level of scrutiny across all providers.
  • Focus risk management resources on third parties that present the greatest operational, financial, compliance, or customer impact.
  • Evaluate contracts, service-level agreements, incident notification processes, and contingency plans for critical service providers. 
  • Recognize that regulators are increasing their focus on core service providers, including transparency, operational resilience, and accountability for misconduct.
  • Use the proposed guidance as an opportunity to reassess vendor risk classifications and scale oversight efforts appropriately for lower- and higher-risk relationships.

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Financial institutions and the move toward tailored third-party risk management