FAC Explorer

Audit 311065

FY End
2023-09-30
Total Expended
$3.65M
Findings
2
Programs
5
Organization: Flagler Hospital, Inc. and Subsidiaries (FL)
Year: 2023 Accepted: 2024-06-28
Auditor: Plante & Moran PLLC

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
404550 2023-002 Material Weakness Yes L
980992 2023-002 Material Weakness Yes L

Programs

ALN Program Spent Major Findings
93.498 Covid-19: Provider Relief Fund (prf) and American Rescue Plan (arp) Rural Distribution $2.62M Yes 1
93.958 Block Grants for Community Mental Health Services $412,711 - 0
14.231 Emergency Solutions Grant Program $405,221 - 0
14.267 Continuum of Care Program $183,241 - 0
93.575 Child Care and Development Block Grant $22,798 - 0

Contacts

Name Title Type
S277U1C5C6N6 Bob Thornton Auditee
9048194069 Adam Stevenson Auditor
No contacts on file

Notes to SEFA

Accounting Policies: The accompanying schedule of expenditures of federal awards (the “Schedule”) includes the federal grant activity of Flagler Hospital, Inc. and Subsidiaries dba Flagler Health+ (the “System”) under programs of the federal government for the year ended September 30, 2023. The information in the 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 (the “Uniform Guidance”). The accompanying schedule of expenditures of state financial assistance projects includes the state project activity of the System under programs of the state government for the year ended September 30, 2023. The information in the schedule of expenditures of state financial assistance projects is presented in accordance with the requirements of the Florida Single Audit Act and Chapter 10.650 of the Rules of the Auditor General. Because the schedule of expenditures of federal awards and schedule of expenditures of state financial assistance projects present 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 assets, or cash flows of the System. Expenditures reported in the schedule of expenditures of federal awards and schedule of expenditures of state financial assistance projects are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; the Florida Single Audit Act; or Chapter 10.650 of the Rules of the Auditor General wherein certain types of expenditures are not allowable or are limited as to reimbursement, except for expenditures related to Assistance Listing Number (ALN) 93.498, Provider Relief Fund and American Rescue Plan Rural Distribution (PRF). PRF does not apply the cost principles contained in Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, but rather applies the U.S. Department of Health and Human Services’ (HHS) guidance and frequently asked questions. For the PRF program, HHS has indicated that the amounts on the schedules should be reported in correspondence with reporting requirements of the HHS PRF Reporting Portal. Payments from HHS for PRF are assigned to a payment received period based upon the date each PRF payment was received. Each period has a specific period of availability and timing of reporting requirements. The pass through entity identifying numbers are presented where available. The System has elected not to use the 10 percent de minimis indirect cost rate to recover indirect costs as allowed under the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: The System has elected not to use the 10 percent de minimis indirect cost rate to recover indirect costs as allowed under the Uniform Guidance.

Finding Details

Finding 2023-002
Assistance Listing Number, Federal Agency, and Program Name – 93.498, U.S. Department of Health and Human Services, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF) Federal Award Identification Number and Year – N/A, 2023 Pass-through Entity – N/A – Direct funded Finding Type – Material weakness and material noncompliance with laws and regulations Repeat Finding – Yes; 2022-001 and 2021-001 Criteria – per the Provider Relief Fund General and Targeted Distributions Post-Payment Notice of Reporting Requirements dated June 11, 2021, recipients may choose to apply PRF payments toward lost revenue using one of three options, up to the amount: Option i: of the difference between actual patient care revenue; Option ii: of the difference between budgeted (prior to March 27, 2020) and actual patient care revenue; or Option iii: calculated by any reasonable method of estimating revenue Condition – The guidelines relating to the reporting of lost revenue for the Provider Relief Fund were not followed. Questioned Costs – None Identification of How Questioned Costs Were Computed – N/A – Refer to context below for additional information. Context – The Period 4 reporting submission for lost revenue did not follow the acceptable options provided by the Department of Health and Human Services. Recipients may choose to apply Provider Relief Fund payments toward lost revenue using one of three options: (i) up to the amount of the difference between actual patient care revenue, (ii) up to the amount of the difference between budgeted (if approved prior to March 27, 2020) and actual patient care revenue, or (iii) up to the amount calculated by any reasonable method of estimating revenue. The System used option ii to calculate lost revenue but the budgeted amounts used in the submission for several periods were not approved by March 27, 2020; therefore, option ii was not allowable. The System should have used option iii to report lost revenue. Additionally, it was identified that the revenue information included in the lost revenue calculation for calendar year 2022 utilized the incorrect months and revenue other than revenue that was patient-related. Cause and Effect – Appropriate review of the reporting submission was not completed to ensure the report followed the required guidelines. As a result, the report submitted was inaccurate and the amount of lost revenue included in the portal submission was understated. Recommendation - We recommend the System implement controls, including levels of review, to ensure reports are completed and submitted in accordance with the guidelines established by HHS. Views of Responsible Officials and Planned Corrective Actions – The System will review and enhance its PRF reporting process by implementing controls to ensure reports are completed and submitted in accordance with the guidelines established by HHS.
Finding 2023-002
Assistance Listing Number, Federal Agency, and Program Name – 93.498, U.S. Department of Health and Human Services, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF) Federal Award Identification Number and Year – N/A, 2023 Pass-through Entity – N/A – Direct funded Finding Type – Material weakness and material noncompliance with laws and regulations Repeat Finding – Yes; 2022-001 and 2021-001 Criteria – per the Provider Relief Fund General and Targeted Distributions Post-Payment Notice of Reporting Requirements dated June 11, 2021, recipients may choose to apply PRF payments toward lost revenue using one of three options, up to the amount: Option i: of the difference between actual patient care revenue; Option ii: of the difference between budgeted (prior to March 27, 2020) and actual patient care revenue; or Option iii: calculated by any reasonable method of estimating revenue Condition – The guidelines relating to the reporting of lost revenue for the Provider Relief Fund were not followed. Questioned Costs – None Identification of How Questioned Costs Were Computed – N/A – Refer to context below for additional information. Context – The Period 4 reporting submission for lost revenue did not follow the acceptable options provided by the Department of Health and Human Services. Recipients may choose to apply Provider Relief Fund payments toward lost revenue using one of three options: (i) up to the amount of the difference between actual patient care revenue, (ii) up to the amount of the difference between budgeted (if approved prior to March 27, 2020) and actual patient care revenue, or (iii) up to the amount calculated by any reasonable method of estimating revenue. The System used option ii to calculate lost revenue but the budgeted amounts used in the submission for several periods were not approved by March 27, 2020; therefore, option ii was not allowable. The System should have used option iii to report lost revenue. Additionally, it was identified that the revenue information included in the lost revenue calculation for calendar year 2022 utilized the incorrect months and revenue other than revenue that was patient-related. Cause and Effect – Appropriate review of the reporting submission was not completed to ensure the report followed the required guidelines. As a result, the report submitted was inaccurate and the amount of lost revenue included in the portal submission was understated. Recommendation - We recommend the System implement controls, including levels of review, to ensure reports are completed and submitted in accordance with the guidelines established by HHS. Views of Responsible Officials and Planned Corrective Actions – The System will review and enhance its PRF reporting process by implementing controls to ensure reports are completed and submitted in accordance with the guidelines established by HHS.