Audit 302428

FY End
2023-06-30
Total Expended
$6.85M
Findings
2
Programs
2
Year: 2023 Accepted: 2024-04-03

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
392216 2023-001 Significant Deficiency - A
968658 2023-001 Significant Deficiency - A

Programs

ALN Program Spent Major Findings
93.498 Provider Relief Fund $6.82M Yes 1
93.155 Rural Health Research Centers $22,750 - 0

Contacts

Name Title Type
QEM1R2KD9CN5 Lynn Lowrie Auditee
8282624119 Jim Creamer Auditor
No contacts on file

Notes to SEFA

Accounting Policies: 1. The accompanying schedule of expenditures of federal awards (Schedule) includes the federal award activity of Appalachian Regional Healthcare System (System) under programs of the federal government for the nine-month period ended June 30, 2023. The information in this Schedule is presented in accordance with the requirements of Title 2 U. S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the Schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the financial position, changes in net position, or cash flows of the System. 2. Expenditures reported on the Schedule are reported on the accrual basis of accounting which is consistent with the preparation of the System’s financial statements. Such expenditures are recognized following the cost principles contained in the Uniform Guidance wherein certain types of expenditures are not allowable or are limited as to reimbursement. The Provider Relief Fund (PRF) amount reported on the Schedule represents the amount reported to the U.S. Department of Health and Human Services HRSA Reporting Portal for Period 4 as specified in the OMB Compliance Supplement. The System did not receive any Period 5 PRF payments. Period 4 includes PRF amounts of the following entities: Legal Entity Name Tax Identification Number Reporting Period AL Number 93.498 Appalachian Regional Medical Associates, Inc. 20-5755130 Period 4 $1,371,719 Charles A. Cannon, Jr. Memorial Hospital, Inc. 56-0529974 Period 4 804,237 Watauga Medical Center, Inc 56-0510824 Period 4 4,648,986 Total $6,824,942 3. The System did not have any non-cash awards during the fiscal year. 4. There were no awards passed through to subrecipients. 5. The System has elected to not use the 10% de minimis indirect cost rate under the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate.

Finding Details

2023-001 - Significant Deficiency Federal agency: U.S. Department of Health and Human Services (HHS) Federal program title: COVID-19 Provider Relief Fund (PRF) - Period 4 Assistance Listing No.: 93.498 Condition: The System over-reported expenses within the HHS Health Resources and Services Administration (HRSA) Reporting Portal Period 4 submission due to a spreadsheet allocation calculation error. Criteria: Provider Relief Funds were provided under the Coronavirus Aid, Relief, and Economic Security Act and are to be used to prevent, prepare for, and respond to coronavirus. The funds shall reimburse the recipient only for expenses or lost revenues that are attributable to coronavirus. The funds may not be used to reimburse expenses or lost revenues that have been reimbursed from other sources or that other sources are obligated to reimburse. Cause: Although the System has a process in place to identify and report allowable expenses, an appropriate review process was not in place to detect and correct spreadsheet calculation errors. Effect: The System reported expenses within the HHS HRSA Reporting Portal Period 4 submission which were not accurately calculated. Questioned Costs: The spreadsheet calculation error resulted in $201,976 of questioned costs. Context: Upon testing the compliance requirements of this program, it was determined that a spreadsheet calculation error resulted in overstating expenditures. However, the Period 4 reporting submission included unused lost revenues that the System believes could offset the the issue identified above. Recommendation: We recommend the Authority design and implement controls, including levels of review, to ensure qualifying expenses submitted are in accordance with the HHS guidelines with supporting documentation retained. Views of Responsible Officials and Planned Corrective Actions: See corrective action plan.
2023-001 - Significant Deficiency Federal agency: U.S. Department of Health and Human Services (HHS) Federal program title: COVID-19 Provider Relief Fund (PRF) - Period 4 Assistance Listing No.: 93.498 Condition: The System over-reported expenses within the HHS Health Resources and Services Administration (HRSA) Reporting Portal Period 4 submission due to a spreadsheet allocation calculation error. Criteria: Provider Relief Funds were provided under the Coronavirus Aid, Relief, and Economic Security Act and are to be used to prevent, prepare for, and respond to coronavirus. The funds shall reimburse the recipient only for expenses or lost revenues that are attributable to coronavirus. The funds may not be used to reimburse expenses or lost revenues that have been reimbursed from other sources or that other sources are obligated to reimburse. Cause: Although the System has a process in place to identify and report allowable expenses, an appropriate review process was not in place to detect and correct spreadsheet calculation errors. Effect: The System reported expenses within the HHS HRSA Reporting Portal Period 4 submission which were not accurately calculated. Questioned Costs: The spreadsheet calculation error resulted in $201,976 of questioned costs. Context: Upon testing the compliance requirements of this program, it was determined that a spreadsheet calculation error resulted in overstating expenditures. However, the Period 4 reporting submission included unused lost revenues that the System believes could offset the the issue identified above. Recommendation: We recommend the Authority design and implement controls, including levels of review, to ensure qualifying expenses submitted are in accordance with the HHS guidelines with supporting documentation retained. Views of Responsible Officials and Planned Corrective Actions: See corrective action plan.