Audit 27124

Finding 2022-001 ? Reporting ? Material Weakness in Internal Control Over Compliance and Instance of Noncompliance Federal Program: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (Assistance Listing #93.498) Federal Agency: U.S. Department of Health and Human Services Award Year: 2020-2021 Criteria: Under the Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Program, providers are required to submit reporting to the Health Resources Services Administration (HRSA) that describes the uses of the funds and how the provider complied with the terms and conditions of the program. Condition: During our testing of the reporting of expenses that were reimbursed by Provider Relief Fund distributions for Period 2, it was identified that $2.4 million of expenses reported as general expenses in Period 2 were also included in the general expenses in Period 1 and were therefore ineligible to be additionally reimbursed. Additionally, approximately $2.4 million of additional lost revenues should have been reported under the selected methodology. Cause: The Medical Center has experienced business and staffing disruptions in recent fiscal years. This situation, coupled with the evolving nature of the specific terms and conditions of the Provider Relief Fund program, is the primary cause. Effect or potential effect: Due to business and staffing disruptions, duplicate expenses and lower lost revenues were reported to HRSA in the reporting Period 2. However, sufficient lost revenues were reported in Period 1 to cover the duplicate expense amount reported of $2.4 million. Questioned costs: None to be reported. Context: During the fiscal year ended September 30, 2022, health care providers were subject to staffing shortages as well as increased operational challenges as a result of the COVID-19 pandemic. As a result, the Medical Center did not have sufficient staffing levels to perform precise reviews to validate the expenses and lost revenue calculation subject to Provider Relief Fund reporting. Identification as a repeat finding, if applicable: This is not a repeat finding. Recommendation: We recommend that the Medical Center implement review controls at a sufficient precision threshold to detect errors and duplicate expense entries in reporting expense amounts that do not comply with the terms and conditions of the Provider Relief Fund Program. Views of responsible officials: Beginning with Period 4 reporting, the Medical Center has implemented an additional review control over the HRSA reporting prior to the report submission.

Finding 2022-001 ? Reporting ? Material Weakness in Internal Control Over Compliance and Instance of Noncompliance Federal Program: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (Assistance Listing #93.498) Federal Agency: U.S. Department of Health and Human Services Award Year: 2020-2021 Criteria: Under the Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Program, providers are required to submit reporting to the Health Resources Services Administration (HRSA) that describes the uses of the funds and how the provider complied with the terms and conditions of the program. Condition: During our testing of the reporting of expenses that were reimbursed by Provider Relief Fund distributions for Period 2, it was identified that $2.4 million of expenses reported as general expenses in Period 2 were also included in the general expenses in Period 1 and were therefore ineligible to be additionally reimbursed. Additionally, approximately $2.4 million of additional lost revenues should have been reported under the selected methodology. Cause: The Medical Center has experienced business and staffing disruptions in recent fiscal years. This situation, coupled with the evolving nature of the specific terms and conditions of the Provider Relief Fund program, is the primary cause. Effect or potential effect: Due to business and staffing disruptions, duplicate expenses and lower lost revenues were reported to HRSA in the reporting Period 2. However, sufficient lost revenues were reported in Period 1 to cover the duplicate expense amount reported of $2.4 million. Questioned costs: None to be reported. Context: During the fiscal year ended September 30, 2022, health care providers were subject to staffing shortages as well as increased operational challenges as a result of the COVID-19 pandemic. As a result, the Medical Center did not have sufficient staffing levels to perform precise reviews to validate the expenses and lost revenue calculation subject to Provider Relief Fund reporting. Identification as a repeat finding, if applicable: This is not a repeat finding. Recommendation: We recommend that the Medical Center implement review controls at a sufficient precision threshold to detect errors and duplicate expense entries in reporting expense amounts that do not comply with the terms and conditions of the Provider Relief Fund Program. Views of responsible officials: Beginning with Period 4 reporting, the Medical Center has implemented an additional review control over the HRSA reporting prior to the report submission.