Audit 292127

Finding 2023-001 – Reporting Federal Program: COVID-19 Provider Relief Fund ALN: 93.498 Federal Agency: U.S. Department of Health and Human Services Federal Award Years: July 1, 2022 through September 30, 2022 Criteria: 45 CFR section 75.303 (a) states non-federal entities must: Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in “Standards for Internal Control in the Federal Government,” issued by the Comptroller General of the United States or the “Internal Control Integrated Framework,” issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). 45 CFR section 75.303 (b) states non-federal entities must: Comply with Federal statutes, regulations, and the terms and conditions of the Federal awards. Recipients of provider relief funds must support all expenses with adequate documentation and maintain proper control documentation to substantiate that these funds were used for health care-related expenses or lost revenues attributable to coronavirus. Condition Found, Including Perspective: There is no evidence of management’s review of reports submitted to the Health Resources and Services Administration (HRSA) reporting portal prior to their submission to the U.S. Department of Health and Human Services for the Period 3 reporting period. Possible Cause and Effect: While Owensboro Health, Inc. maintains that a management review did occur prior to submission, controls were not designed or implemented effectively to maintain evidence of management’s manual review. Such reviews occurred verbally over phone calls, online meeting platforms, and emails, which were not recorded or retained. A similar finding was communicated in the prior year subsequent to Owensboro Health, Inc. submitting its Period 3 portal reporting to HRSA. Owensboro Health, Inc. remediated the finding concurrent with its Period 4 portal reporting to HRSA. Questioned Costs: None. Statistical Validity: The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding in the Prior Year: This is a repeat finding. Recommendation We recommend that management continue to monitor its design of management review controls to ensure that documentation of management reviews of federal reports is consistently maintained. Views of Responsible Officials: Owensboro Health, Inc. implemented controls and processes to ensure grant reports are reviewed prior to submission and that evidence of review is maintained. These controls and processes were in place for the Period 4 submission.

Finding 2023-001 – Reporting Federal Program: COVID-19 Provider Relief Fund ALN: 93.498 Federal Agency: U.S. Department of Health and Human Services Federal Award Years: July 1, 2022 through September 30, 2022 Criteria: 45 CFR section 75.303 (a) states non-federal entities must: Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in “Standards for Internal Control in the Federal Government,” issued by the Comptroller General of the United States or the “Internal Control Integrated Framework,” issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). 45 CFR section 75.303 (b) states non-federal entities must: Comply with Federal statutes, regulations, and the terms and conditions of the Federal awards. Recipients of provider relief funds must support all expenses with adequate documentation and maintain proper control documentation to substantiate that these funds were used for health care-related expenses or lost revenues attributable to coronavirus. Condition Found, Including Perspective: There is no evidence of management’s review of reports submitted to the Health Resources and Services Administration (HRSA) reporting portal prior to their submission to the U.S. Department of Health and Human Services for the Period 3 reporting period. Possible Cause and Effect: While Owensboro Health, Inc. maintains that a management review did occur prior to submission, controls were not designed or implemented effectively to maintain evidence of management’s manual review. Such reviews occurred verbally over phone calls, online meeting platforms, and emails, which were not recorded or retained. A similar finding was communicated in the prior year subsequent to Owensboro Health, Inc. submitting its Period 3 portal reporting to HRSA. Owensboro Health, Inc. remediated the finding concurrent with its Period 4 portal reporting to HRSA. Questioned Costs: None. Statistical Validity: The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding in the Prior Year: This is a repeat finding. Recommendation We recommend that management continue to monitor its design of management review controls to ensure that documentation of management reviews of federal reports is consistently maintained. Views of Responsible Officials: Owensboro Health, Inc. implemented controls and processes to ensure grant reports are reviewed prior to submission and that evidence of review is maintained. These controls and processes were in place for the Period 4 submission.