Audit 27397

Identification of the Federal Program: Federal Assistance Listing Number 93.498 US Department of Health and Human Services Provider Relief Fund Criteria or Specific Requirement: The terms and conditions of the CARES Act Provider Relief Fund (PRF) distributions state that funds are not to be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. Condition: During the process of identifying expenses that were incurred to prevent, prepare for or respond to the coronavirus pandemic, certain expenses that were reported in the PRF submission were not reduced by amounts reimbursed by other sources. Cause: Due to the amount of detailed information that was required to be compiled by management in order to enter data into the PRF reporting portal, management inadvertently included in eligible expenses certain expenses that were also reimbursed by Medicare and Medicaid through cost-based reimbursement. Effect or Potential Effect: Management included amounts in the PRF reporting portal which were not eligible based on the terms and conditions of the PRF distributions. Questioned Costs: Total questioned costs related to Federal Assistance Listing Number 93.498 amounted to $91,650 and were calculated based off the underlying expense detail management used to populate the PRF reporting portal and the estimate Medicare and Medicaid cost-based reimbursement percentage. Context: The PRF and HRSA guidance states that costs cannot be used to reimburse expenses or losses that have been or are obligated to be reimbursed by other sources. Certain fringe benefit expenses were identified as being claimed for reimbursement through both the PRF reporting portal submission, and cost-based reimbursement from Medicare and Medicaid. Recommendation: We recommend that management continue to monitor and enhance its internal controls over federal award compliance to ensure that only eligible costs are included in amounts expended and that the same expenses are not for multiple grant awards. Views of Responsible Officials and Planned Corrective Actions: Management agrees with the noted finding. However, the Hospital had also incurred sufficient lost revenue that if the noted questioned costs had not been reported, the Hospital would have satisfactorily incurred eligible expenses in excess of the PRF funds received, including interest earned on such funds.

Item 2022-005 Significant Deficiency Identification of the Federal Program: Federal Assistance Listing Number 93.498 US Department of Health and Human Services Provider Relief Fund Criteria or Specific Requirement: The terms and conditions of the CARES Act Provider Relief Fund (PRF) state that funds are only to be used to prevent, prepare for and respond to coronavirus, and that funds may only be used for healthcare related expenses or lost revenue that is attributable to the coronavirus. Subsequent guidance issued by the Health Resources and Services Administration (HRSA) states that recipients may use payments for eligible expenses incurred prior to the receipt of the PRF distributions dating back to January 1, 2020, so long as they are to prevent, prepare for, and respond to coronavirus. Condition: During the process of identifying expenses and capital costs that were incurred to prevent, prepare for or respond to the coronavirus pandemic, management included capital items for which there was a lack of supporting documentation. Cause: Due to the amount of detailed information that was required to be compiled by management in order to enter data into the PRF reporting portal, management inadvertently included capital items which could not be supported by auditable evidence. Effect or Potential Effect: Management included amounts in the PRF reporting portal which were not eligible based on the terms and conditions of the PRF distributions and subsequent HRSA guidance. Questioned Costs: Total questioned costs related to Federal Assistance Listing Number 93.498 amounted to $678,214 and were calculated based off the underlying capital asset listing management used to populate the PRF reporting portal and comparing such amounts to the Hospital?s depreciation schedule. Context: Certain costs were included on the PRF submission which could not be supported by audit evidence. Recommendation: We recommend that management continue to monitor and enhance its internal controls over federal award compliance to ensure that only eligible costs are included in amounts expended. Views of Responsible Officials and Planned Corrective Actions: Management agrees with the noted finding. However, the Hospital had also incurred sufficient unreimbursed expenses that if the noted questioned costs had not been reported, the Hospital would have satisfactorily incurred eligible expenses in excess of the PRF funds received, including interest earned on such funds.

Identification of the Federal Program: Federal Assistance Listing Number 93.498 US Department of Health and Human Services Provider Relief Fund Criteria or Specific Requirement: The terms and conditions of the CARES Act Provider Relief Fund (PRF) distributions state that funds are not to be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. Condition: During the process of identifying expenses that were incurred to prevent, prepare for or respond to the coronavirus pandemic, certain expenses that were reported in the PRF submission were not reduced by amounts reimbursed by other sources. Cause: Due to the amount of detailed information that was required to be compiled by management in order to enter data into the PRF reporting portal, management inadvertently included in eligible expenses certain expenses that were also reimbursed by Medicare and Medicaid through cost-based reimbursement. Effect or Potential Effect: Management included amounts in the PRF reporting portal which were not eligible based on the terms and conditions of the PRF distributions. Questioned Costs: Total questioned costs related to Federal Assistance Listing Number 93.498 amounted to $91,650 and were calculated based off the underlying expense detail management used to populate the PRF reporting portal and the estimate Medicare and Medicaid cost-based reimbursement percentage. Context: The PRF and HRSA guidance states that costs cannot be used to reimburse expenses or losses that have been or are obligated to be reimbursed by other sources. Certain fringe benefit expenses were identified as being claimed for reimbursement through both the PRF reporting portal submission, and cost-based reimbursement from Medicare and Medicaid. Recommendation: We recommend that management continue to monitor and enhance its internal controls over federal award compliance to ensure that only eligible costs are included in amounts expended and that the same expenses are not for multiple grant awards. Views of Responsible Officials and Planned Corrective Actions: Management agrees with the noted finding. However, the Hospital had also incurred sufficient lost revenue that if the noted questioned costs had not been reported, the Hospital would have satisfactorily incurred eligible expenses in excess of the PRF funds received, including interest earned on such funds.

Item 2022-005 Significant Deficiency Identification of the Federal Program: Federal Assistance Listing Number 93.498 US Department of Health and Human Services Provider Relief Fund Criteria or Specific Requirement: The terms and conditions of the CARES Act Provider Relief Fund (PRF) state that funds are only to be used to prevent, prepare for and respond to coronavirus, and that funds may only be used for healthcare related expenses or lost revenue that is attributable to the coronavirus. Subsequent guidance issued by the Health Resources and Services Administration (HRSA) states that recipients may use payments for eligible expenses incurred prior to the receipt of the PRF distributions dating back to January 1, 2020, so long as they are to prevent, prepare for, and respond to coronavirus. Condition: During the process of identifying expenses and capital costs that were incurred to prevent, prepare for or respond to the coronavirus pandemic, management included capital items for which there was a lack of supporting documentation. Cause: Due to the amount of detailed information that was required to be compiled by management in order to enter data into the PRF reporting portal, management inadvertently included capital items which could not be supported by auditable evidence. Effect or Potential Effect: Management included amounts in the PRF reporting portal which were not eligible based on the terms and conditions of the PRF distributions and subsequent HRSA guidance. Questioned Costs: Total questioned costs related to Federal Assistance Listing Number 93.498 amounted to $678,214 and were calculated based off the underlying capital asset listing management used to populate the PRF reporting portal and comparing such amounts to the Hospital?s depreciation schedule. Context: Certain costs were included on the PRF submission which could not be supported by audit evidence. Recommendation: We recommend that management continue to monitor and enhance its internal controls over federal award compliance to ensure that only eligible costs are included in amounts expended. Views of Responsible Officials and Planned Corrective Actions: Management agrees with the noted finding. However, the Hospital had also incurred sufficient unreimbursed expenses that if the noted questioned costs had not been reported, the Hospital would have satisfactorily incurred eligible expenses in excess of the PRF funds received, including interest earned on such funds.