Audit 296676

Federal Program Name: COVID – 19 Provider Relief Fund (PRF) Federal Agency: U.S. Department of Health and Human Services Federal Assistance Listing Title and Number: COVID-19 Provider Relief Fund, 93.498 Criteria or Specific Requirement: Reporting - 2 CFR 200.303(a) requires a non-Federal entity to establish and maintain effective internal control over Federal awards 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. Also, per the terms and conditions of the Provider Relief Fund, amounts are to be used to prevent, prepare for, and respond to coronavirus and payments shall only be used to reimburse the Hospital for health care related expenses or lost revenues that are attributable to coronavirus. Condition: Lost revenues attributable to COVID-19 were not properly calculated and reported for Provider Relief Fund Portal reporting Period 3 and 4. Questioned Costs: None Context: The Hospital reported lost revenues using the actual revenues for 2022 compared to actual revenues for 2019. During specific quarters in Period 3 and 4 reporting, the Hospital did not include all patient revenues including those from the nursing home supplemental payment program in its calculation of lost revenues. This presentation did not conform with guidance published by the Health Resources and Services Administration (HRSA). Errors were identified by reconciling figures to underlying financial information. Effect: The Hospital did not properly calculate, and report lost revenues. Cause: Internal controls surrounding the review and submission of required reports were not adequately applied to ensure accuracy of required elements. Repeat Findings: Yes Recommendation: We recommend the Hospital evaluate lost revenues under published HRSA guidance and prepare a revised calculation that can be provided, if necessary, upon any further review. Views of Responsible Officials and Planned Corrective Action: We concur. When evaluating all uses of Provider Relief Funds, we have adequate expenses and lost revenues to support funding reported without consideration to the lost revenues reported in Period 3 and 4.

Federal Program Name: COVID – 19 Provider Relief Fund (PRF) Federal Agency: U.S. Department of Health and Human Services Federal Assistance Listing Title and Number: COVID-19 Provider Relief Fund, 93.498 Criteria or Specific Requirement: 2 CFR 200.512(a) requires that the Hospital’s audit must be completed and the data collection form described in paragraph (b) of this section and reporting package described in paragraph (c) of this section must be submitted within the earlier of 30 calendar day safter receipt of the auditor’s report(s), or nine months after the end of the audit period. Condition: The Hospital’s audit report was not finalized and submitted during the required time period. Questioned Costs: None Context: The Hospital’s audit report was not finalized and submitted during the required time period. Effect: The Hospital did not comply with the requirements of 2 CFR 200.512(a). Cause: Internal controls surrounding the accumulation of data from the Hospital’s nursing home operations as prepared by third party managers was delayed Repeat Findings: No Recommendation: We recommend that the Hospital obtain and review periodic financial statements of each of the nursing homes and review internal calculations of amounts due under management agreements. Financial information should be included in the Hospital’s financial statements on a routine basis. Views of Responsible Officials and Planned Corrective Action: We concur. Management continues to evaluate current controls related to accounting for the nursing home operations to ensure that transactions are accounted for properly and in a timely manner to allow for completion of required audit procedures within the timelines identified above.

Federal Program Name: COVID – 19 Provider Relief Fund (PRF) Federal Agency: U.S. Department of Health and Human Services Federal Assistance Listing Title and Number: COVID-19 Provider Relief Fund, 93.498 Criteria or Specific Requirement: Reporting - 2 CFR 200.303(a) requires a non-Federal entity to establish and maintain effective internal control over Federal awards 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. Also, per the terms and conditions of the Provider Relief Fund, amounts are to be used to prevent, prepare for, and respond to coronavirus and payments shall only be used to reimburse the Hospital for health care related expenses or lost revenues that are attributable to coronavirus. Condition: Lost revenues attributable to COVID-19 were not properly calculated and reported for Provider Relief Fund Portal reporting Period 3 and 4. Questioned Costs: None Context: The Hospital reported lost revenues using the actual revenues for 2022 compared to actual revenues for 2019. During specific quarters in Period 3 and 4 reporting, the Hospital did not include all patient revenues including those from the nursing home supplemental payment program in its calculation of lost revenues. This presentation did not conform with guidance published by the Health Resources and Services Administration (HRSA). Errors were identified by reconciling figures to underlying financial information. Effect: The Hospital did not properly calculate, and report lost revenues. Cause: Internal controls surrounding the review and submission of required reports were not adequately applied to ensure accuracy of required elements. Repeat Findings: Yes Recommendation: We recommend the Hospital evaluate lost revenues under published HRSA guidance and prepare a revised calculation that can be provided, if necessary, upon any further review. Views of Responsible Officials and Planned Corrective Action: We concur. When evaluating all uses of Provider Relief Funds, we have adequate expenses and lost revenues to support funding reported without consideration to the lost revenues reported in Period 3 and 4.

Federal Program Name: COVID – 19 Provider Relief Fund (PRF) Federal Agency: U.S. Department of Health and Human Services Federal Assistance Listing Title and Number: COVID-19 Provider Relief Fund, 93.498 Criteria or Specific Requirement: 2 CFR 200.512(a) requires that the Hospital’s audit must be completed and the data collection form described in paragraph (b) of this section and reporting package described in paragraph (c) of this section must be submitted within the earlier of 30 calendar day safter receipt of the auditor’s report(s), or nine months after the end of the audit period. Condition: The Hospital’s audit report was not finalized and submitted during the required time period. Questioned Costs: None Context: The Hospital’s audit report was not finalized and submitted during the required time period. Effect: The Hospital did not comply with the requirements of 2 CFR 200.512(a). Cause: Internal controls surrounding the accumulation of data from the Hospital’s nursing home operations as prepared by third party managers was delayed Repeat Findings: No Recommendation: We recommend that the Hospital obtain and review periodic financial statements of each of the nursing homes and review internal calculations of amounts due under management agreements. Financial information should be included in the Hospital’s financial statements on a routine basis. Views of Responsible Officials and Planned Corrective Action: We concur. Management continues to evaluate current controls related to accounting for the nursing home operations to ensure that transactions are accounted for properly and in a timely manner to allow for completion of required audit procedures within the timelines identified above.