The Eureka Springs Hospital Commission’s January 19 meeting heard CEO Tiffany Means explaining issues with hospital financials.
Means said that years 2023–24 were where issues with hospital finances began. She said she and interim CFO Doug Hoban performed an investigation after the firing of Cynthia Abury and had spoken with Forvis accounting firm about the financial “material weakness” of the hospital. Many of these issues have also been listed by city council in the past. The list included:
- Monthly financial reporting was not reliable
- Capital assets were not being tracked leading to audit adjustments to correct balances
- Accrued payroll had been incorrectly calculated
- Leases had failed to be recorded in compliance with GASB87 [government accounting]
- Subscription based IT arrangements were not recorded in compliance with GASB96
- Cash reconciliations were inaccurate or incomplete leading to audit adjustments
- Patient Accounts Receivables were failing to be tracked
- Accounts payable policies were insufficient, meaning there errors would occur and not be found in “a timely manner”
Means said these issues directly impact the hospital’s ability to plan. She said in reviewing rolling monthly financials through Nov. 2025 that many of these issues had not been resolved. She also noted that bad debt expenses had been left largely unrecorded and depreciation expenses had remained unchanged for 10 months. Means said with these issues, she and Hoban could not present the commission with December financials.
Means said she and Hoban had found revenue cycle and billing issues, as well as vendor contracts, that had not been reviewed or updated in several years. She said that hospital leadership had begun reviewing all active contracts to ensure the hospital is not being billed for services that are no longer provided or required. Contracts will also be updated and in some cases competitively bid on, in compliance with state law.
Continuing to acknowledge billing errors, Means explained that in December the hospital had received calls that patients were receiving collection notices for 2024 services without previously receiving billing statements. The investigation on Dec. 29 showed that when the hospital migrated accounts to Oracle there was a “lack of documented review” of accounts.
Accounts that were placed with a former collections’ vendor later sold them to the current agency, Midsouth, and when Midsouth realized they had never addressed those accounts, letters were sent out. Means said that billing policy was being revised, accounts and collection activity were being reviewed, and that hospital staff had spoken with many affected patients about this error.
Hoban added that it’s “no secret” the hospital has had a decrease of 38 percent in cash reserves in 2025, and noted that contractual reserves monthly would have swings of 35–111 percent of gross revenue generated each month. He said that the audit with Forvis had led to a discussion in September of how to calculate reserves for bad debt, though a solution had never been implemented as far as he could find.
Asked if anything illegal had been committed, Hoban said he couldn’t say with certainty, but most issues were a lack of “in depth review.” Commissioner Vivian Smith asked how the commission could have seen this more clearly, and Means said she had tried to “share transparency in the presentation in a better way but it was met with an unwillingness to do so.” She said that moving forward, there will be more items on the financials for both the commission and public to see.
Clinical Report
Clinical Nurse Executive Velvet Shoults read a positive letter regarding a patient’s treatment at the hospital before going into updates on staffing and number of ambulance visits and patients for December 2025 and January 2026. Two public meeting rooms will be opening, and the hospital is working out an agreement with Survival Flight for aircraft and crew to be based out of the hospital. Survival Flight is an emergency medical transportation company.
Shoults said to anticipate March – April to be when that agreement is set, mentioning that procurement of the aircraft is the hold up. Like other emergency medical transport companies, membership would be an annual premium to cover what insurance will not cover should a patient need flight out.