Audit 305972

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.

Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.