Audit 315652

FY End
2023-12-31
Total Expended
$94.67M
Findings
2
Programs
35
Organization: Ahs Hospital Corp. (NJ)
Year: 2023 Accepted: 2024-07-23

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
479156 2023-001 - - L
1055598 2023-001 - - L

Programs

ALN Program Spent Major Findings
97.036 Covid-19 Federal Emergency Management Disaster Relief Public Assistance $51.94M - 0
21.027 Covid-19 Coronavirus State Fiscal Recovery Fund Project 2024 $28.58M Yes 0
93.498 Covid-19 Provider Relief Program and American Rescue Plan (arp) Rural Distributon $8.71M Yes 1
21.027 Covid-19 Western Region Plant Modernization $2.43M Yes 0
93.399 Cancer Control $799,873 - 0
93.493 Community Project Funding/congressional Directed Spending - Construction $750,000 Yes 0
93.914 Ryan White Part A Hiv Emergency Relief Grant Program 2024 $380,042 - 0
93.116 Tuberculosis Ambulatory Care 2023 $150,074 - 0
93.940 Dhsts Federal Hiv Prevention Program 2023 $141,224 - 0
84.191 Early Intervention Program $140,215 - 0
20.600 Hts Federal Highway Safety Grant 2023 Morris County Safe Communities $77,976 - 0
93.898 New Jersey Cancer Education and Early Detection 2023 $65,520 - 0
97.067 Ffy21 Urban Area Security Initiative (uasi-Local Share) $55,600 - 0
93.914 Ryan White Part A Hiv Emergency Relief Grant Program 2023 $49,559 - 0
93.394 M.d. Anderson Edrn-Cvc for Early Detection of Ovarian Cancer (00004221) $39,837 - 0
93.994 Special Child Health Case Management 2023 $34,001 - 0
93.394 Randomized Prospective Phase II Clinical Trial of Nvx-108 in Association with Chemoradiation of Glioblastoma $33,199 - 0
93.994 Special Child Health Case Management 2024 $28,889 - 0
93.994 Special Child Health Child Evaluation Centers 2023 $28,834 - 0
93.497 Covid-19 Sexual Violence Direct Services $26,208 - 0
20.600 Hts Federal Highway Safety Grant 2024 Morris County Safe Communities $24,942 - 0
93.994 Special Child Health Child Evaluation Centers 2024 $22,836 - 0
93.958 Covid-19 Peer Support $18,275 - 0
93.395 Network Group Operations Center (medical Research Foundation) $15,800 - 0
93.855 Effect of Il-4rar576 Variant on Response to Dupilumab in Children with Asthma (idea) $14,527 - 0
16.575 Sexual Assault Response Team (sart)/forensic Nurse Examiner (fne) $13,894 - 0
93.898 New Jersey Cancer Education and Early Detection 2024 $10,765 - 0
17.268 H-1b Job Training Grants $8,735 - 0
93.837 Clinical, Electrocardiographic & Cardiac Magnetic Resonance Imaging Risk Factors Associated with Ventricular Tachyarrhythmias in Nonischemic Cardiomyopathy Urf (awd00002150) $4,170 - 0
93.866 Home-Based Cardiac Rehabilitation Using A Novel Mobile Health Exercise Regimen Following Transcatheter Heart Valve Interventions (home Run Hitter) $3,488 - 0
93.847 Clinical, Imaging, and Endoscopic Outcomes of Children Newly Diagnosed with Crohn's Disease (cameo) $2,150 - 0
93.395 Nci Cog/phi Nctn Network Group Operations Center (ar07544) $1,000 - 0
93.855 Comparative Effectiveness and Complications of Intravenous Ceftriaxone Compared with Oral Doxycycline in Lyme Meningitis $686 - 0
93.847 Type 1 Diabetes Trialnet $620 - 0
84.191 Covid-19 Early Intervention Program $150 - 0

Contacts

Name Title Type
CBEMLJBKLZB4 Katharine Driebe Auditee
9734512027 Kate Corgel Auditor
No contacts on file

Notes to SEFA

Title: COVID-19 Department of Homeland Security Federal Emergency Management Agency (FEMA) Accounting Policies: The information on the Schedule of Expenditures of Federal Awards (the "Federal Schedule") is reported on the accrual basis of accounting and is presented in accordance with the requirements of the Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (“Uniform Guidance”). Therefore, some amounts presented in this Federal Schedule may differ from amounts presented in or used in preparation of the basic consolidated financial statements. The purpose of the Federal Schedule is to present a summary of those activities of the Hospital for the year ended December 31, 2023 which have been financed by the federal government. For purposes of the Federal Schedule, federal awards include any assistance provided by a federal agency directly or indirectly in the form of grants, contracts and loan and loan guarantees. Direct and indirect costs are charged to awards in accordance with cost principles contained in the Department of Health and Human Services (“DHHS”), U.S. Office of the Assistant Secretary Comptroller (“OASC”), OASC-3, A Guide for Hospitals. Under these cost principles, certain types of expenditures are not allowable or are limited as to reimbursement. Because the Federal Schedule presents only a selected portion of the activities of the Hospital, it is not intended to, and does not present the consolidated financial position, results of operations, changes in net assets or cash flows of the Hospital. Full Assistance Listing Numbers (“ALN”) and pass-through entity numbers are included when available. While certain awards on the Federal Schedule have program names identified as award year 2024, only expenses incurred during the year ended December 31, 2023 are reported on the Federal Schedule. These awards have grant periods that do not align with the Hospital’s calendar year end. De Minimis Rate Used: N Rate Explanation: Indirect costs are recovered at the lower of the rate specified under the grant agreement or the Hospital’s approved indirect cost rate of 55%, rather than the allowed de minimus rate of 10%. For the year ended December 31, 2023, the Hospital recorded $51,944,204 of claims to FEMA under ALN 97.036. The claims submitted represented incurred eligible capital and operating expenses attributed to the Hospital’s response to COVID-19, which were not only expended, but also approved by the federal and state agencies. The Hospital has additional claims outstanding and under review with FEMA as of December 31, 2023 which will be recognized in the year the related funds are approved by FEMA at the federal and state agencies.
Title: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Accounting Policies: The information on the Schedule of Expenditures of Federal Awards (the "Federal Schedule") is reported on the accrual basis of accounting and is presented in accordance with the requirements of the Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (“Uniform Guidance”). Therefore, some amounts presented in this Federal Schedule may differ from amounts presented in or used in preparation of the basic consolidated financial statements. The purpose of the Federal Schedule is to present a summary of those activities of the Hospital for the year ended December 31, 2023 which have been financed by the federal government. For purposes of the Federal Schedule, federal awards include any assistance provided by a federal agency directly or indirectly in the form of grants, contracts and loan and loan guarantees. Direct and indirect costs are charged to awards in accordance with cost principles contained in the Department of Health and Human Services (“DHHS”), U.S. Office of the Assistant Secretary Comptroller (“OASC”), OASC-3, A Guide for Hospitals. Under these cost principles, certain types of expenditures are not allowable or are limited as to reimbursement. Because the Federal Schedule presents only a selected portion of the activities of the Hospital, it is not intended to, and does not present the consolidated financial position, results of operations, changes in net assets or cash flows of the Hospital. Full Assistance Listing Numbers (“ALN”) and pass-through entity numbers are included when available. While certain awards on the Federal Schedule have program names identified as award year 2024, only expenses incurred during the year ended December 31, 2023 are reported on the Federal Schedule. These awards have grant periods that do not align with the Hospital’s calendar year end. De Minimis Rate Used: N Rate Explanation: Indirect costs are recovered at the lower of the rate specified under the grant agreement or the Hospital’s approved indirect cost rate of 55%, rather than the allowed de minimus rate of 10%. During the year ended December 31, 2022, the Hospital received Provider Relief Funds (“PRF”) from DHHS ALN 93.498, as further described in Note 5 to the consolidated financial statements. Pursuant to the guidance provided by DHHS, the Federal Schedule includes all Period 5 funds received between January 1, 2022 and June 30, 2022 and expended by June 30, 2023 as reported to Health Resources and Services Administration (“HRSA”) via the PRF Reporting Portal. The Hospital did not receive any Period 6 funds.

Finding Details

2023-001: Provider Relief Fund Reporting Cluster: Not applicable Federal Granting Agency: DHHS Health Resources and Services Administration (HRSA) Award Name: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing Number: 93.498 Assistance Listing Title: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Award Year: January 1, 2020 – June 30, 2023 Criteria: Per the HRSA Provider Relief Fund (PRF) Lost Revenues Guide, PRF payment amounts may be applied to patient care lost revenues that have not been reimbursed by other sources. Patient care includes health care, services and supports, as provided in a medical setting, at home/telehealth, or in the community. Items not considered to be patient care include, but are not limited to, insurance, non-patient care, dining services, fundraising events, prescription sales revenues, grants or tuition, amounts of charity care adjustments, bad debt, retail, auxiliary or parking services, real estate revenues, amounts of contractual adjustments from all third-party payers and any gains and/or losses on investments. Condition: The Hospital completed two separate Period 5 PRF Reporting Portal submissions (one for AHS Hospital Corp and one for AMG). In both submissions, the Hospital attested to calculating lost revenues using Option (ii) per the HRSA User Guide – the difference between budgeted and actual patient care revenues for each quarter during the period of availability. However, within the AMG submission, management included approximately $3.3 million of other operating revenue that does not meet the HRSA User Guide definition of patient care lost revenues as noted above in the Criteria. Cause: Management erroneously included other operating revenue in the AMG submission in conjunction with the preparation and completion of the Period 5 PRF Reporting Portal submission. Effect: As management chose Option (ii) for the AMG submission and the budgets for July 1, 2022 to June 30, 2023 were not approved prior to March 27, 2020, the budget in those periods for the AMG submission was appropriately reported as zero. Although the actual patient care revenue reported was inaccurate, there was no impact to the amount of lost revenues reported for those periods as actuals exceeded the budget. Additionally, there were sufficient lost revenues related to the initial reporting period of January 1, 2020 to December 31, 2020 to cover the PRF amounts received and reported in Period 5, consistent with the AMG submission. Questioned Costs: Although the actual patient care revenue reported was inaccurate, there was no impact to the amount of lost revenues reported for those periods as actuals exceeded the budget. Additionally, there were sufficient lost revenues related to the initial reporting period of January 1, 2020 to December 31, 2020 to cover the PRF amounts received and reported in Period 5, consistent with the AMG submission. Recommendation: If future PRF funding is received, we recommend management enhance its control around the review of HRSA guidance to ensure proper review of all elements and inclusion of appropriate information (i.e. lost revenues) prior to any required future submissions to the portal. Management’s Views and Corrective Action Plan: Management’s response is included in “Management’s Views and Corrective Action Plan” included at the end of this report.
2023-001: Provider Relief Fund Reporting Cluster: Not applicable Federal Granting Agency: DHHS Health Resources and Services Administration (HRSA) Award Name: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing Number: 93.498 Assistance Listing Title: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Award Year: January 1, 2020 – June 30, 2023 Criteria: Per the HRSA Provider Relief Fund (PRF) Lost Revenues Guide, PRF payment amounts may be applied to patient care lost revenues that have not been reimbursed by other sources. Patient care includes health care, services and supports, as provided in a medical setting, at home/telehealth, or in the community. Items not considered to be patient care include, but are not limited to, insurance, non-patient care, dining services, fundraising events, prescription sales revenues, grants or tuition, amounts of charity care adjustments, bad debt, retail, auxiliary or parking services, real estate revenues, amounts of contractual adjustments from all third-party payers and any gains and/or losses on investments. Condition: The Hospital completed two separate Period 5 PRF Reporting Portal submissions (one for AHS Hospital Corp and one for AMG). In both submissions, the Hospital attested to calculating lost revenues using Option (ii) per the HRSA User Guide – the difference between budgeted and actual patient care revenues for each quarter during the period of availability. However, within the AMG submission, management included approximately $3.3 million of other operating revenue that does not meet the HRSA User Guide definition of patient care lost revenues as noted above in the Criteria. Cause: Management erroneously included other operating revenue in the AMG submission in conjunction with the preparation and completion of the Period 5 PRF Reporting Portal submission. Effect: As management chose Option (ii) for the AMG submission and the budgets for July 1, 2022 to June 30, 2023 were not approved prior to March 27, 2020, the budget in those periods for the AMG submission was appropriately reported as zero. Although the actual patient care revenue reported was inaccurate, there was no impact to the amount of lost revenues reported for those periods as actuals exceeded the budget. Additionally, there were sufficient lost revenues related to the initial reporting period of January 1, 2020 to December 31, 2020 to cover the PRF amounts received and reported in Period 5, consistent with the AMG submission. Questioned Costs: Although the actual patient care revenue reported was inaccurate, there was no impact to the amount of lost revenues reported for those periods as actuals exceeded the budget. Additionally, there were sufficient lost revenues related to the initial reporting period of January 1, 2020 to December 31, 2020 to cover the PRF amounts received and reported in Period 5, consistent with the AMG submission. Recommendation: If future PRF funding is received, we recommend management enhance its control around the review of HRSA guidance to ensure proper review of all elements and inclusion of appropriate information (i.e. lost revenues) prior to any required future submissions to the portal. Management’s Views and Corrective Action Plan: Management’s response is included in “Management’s Views and Corrective Action Plan” included at the end of this report.