A February follow-up inspection of Johns Hopkins All Children’s Hospital found the hospital was still out of compliance with federal rules, officials said this week.

Federal regulators cited problems with the hospital’s governance, quality assurance and infection control, and gave it a new deadline of mid-April to resolve the issues.

In a letter to Johns Hopkins Health System President Kevin Sowers Thursday, the Centers for Medicare and Medicaid Services said it would withhold public funding if the hospital missed the deadline.

It was the second letter the federal government has sent threatening to withhold funding. On Jan. 31, All Children’s was placed at risk of losing federal money because of problems with its governing board that put patients in “immediate jeopardy” of harm. Those specific problems have been addressed, federal regulators said.

[ Read the findings from the January inspection: New federal report details widespread problems at All Children’s ]

All Children’s spokeswoman Kim Hoppe called Thursday’s action “an anticipated step in the right direction in this long and important process.”

“We take the issues raised by our regulators very seriously and will continue to collaborate closely with them as we implement our plan of correction,” she said in a statement.

But U.S. Reps. Charlie Crist and Kathy Castor, who pushed for a federal investigation into All Children’s, said the hospital could still face “a serious penalty reflecting the serious mismanagement that led to unthinkable tragedy and lost lives.”

“While All Children’s works to regain their standing and begin restoring the community’s trust, it’s clear the oversight of our hospital systems needs reform,” they said in a joint statement. “We are exploring legislation that would strengthen oversight to prevent what happened here from occurring again.”

In November, a Tampa Bay Times investigation revealed that the death rate for All Children’s heart surgery patients had spiked from 2015 to 2017. The rate was three times the statewide average and the highest of any children’s heart surgery program in Florida.

[ Read the investigation: Johns Hopkins promised to elevate All Children’s Heart Institute. Then patients started to die at an alarming rate. ]

[ More coverage: State, federal officials missed warnings at All Children’s heart unit ]

The Times also found regulators missed signs of serious problems within the heart department. The federal government had planned to investigate in 2018, but left a review to an independent accrediting agency.

Days after the investigation was published, several top All Children’s executives resigned. The hospital released a statement saying the Times’ findings were “unacceptable.”

[ Read more: Top All Children’s executives resign following Times report on heart surgeries ]

[ Also: Three more All Children’s officials resign following Times investigation ]

State and federal investigators showed up at the hospital in January and documented a series of deficiencies, including some severe enough to constitute “an immediate or serious threat to patient health and safety.”

Among them: the fact that virtually all authority had rested with a few executives and the board of trustees had failed to exercise proper oversight.

Last month, the federal government said All Children’s had addressed its most pressing concerns. But Thursday’s notice pointed to outstanding issues with the hospital’s leadership structure and the hiring and management of doctors.

Details on what the inspection found were not immediately available. The federal government said it would release the reports after the hospital files a corrective plan.

That plan is due March 17.

Hospitals almost always are able to address federal regulators’ complaints without losing public funding. Just three hospitals in the United States had the money withheld last fiscal year.

[ Click here to read all of the Times’ coverage of All Children‘s Heart Institute ]

The All Children’s statement

Here is the full text of the statement from the hospital:

On February 22, Johns Hopkins All Children’s received word from the federal Centers for Medicare & Medicaid Services (CMS) that they had accepted our Plan of Correction and through an on-site survey validated that Immediate Jeopardy (IJ) was removed.

Yesterday, as expected, CMS officially notified us that, as a result of corrective actions taken by Johns Hopkins All Children’s Hospital, the same areas that had previously contributed to our IJ status are now considered to be “condition level,” which is an anticipated step in the right direction in this long and important process. We take the issues raised by our regulators very seriously and will continue to collaborate closely with them as we implement our Plan of Correction.