Audit 327536

Department of Health and Human Services Federal Financial Assistance Listing #93.332 Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges Reporting Significant Deficiency in Internal Control over Compliance Criteria - 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition – There was no evidence retained that the Medical Center’s compliance and financial reports submitted to the Department of Health and Human Services were reviewed and approved prior to submission. Cause - The Medical Center did have an internal control policy in place to ensure documented review and approval of the compliance and financial reports was documented; however, this was not followed consistently throughout the year. Effect - The lack of adequate policies governing review and approval increases the risk that employees participating in the federal awards administration may not be able to detect and correct noncompliance in a timely manner. Questioned Costs - None Reported. Context/Sampling - A nonstatistical sample of 10 out of 69 reports were selected for detail testing and 5 did not include evidence of a review by someone other than the preparer. Repeat Finding from Prior Year(s) – Yes, 2022-002 Recommendation - We recommend the Medical Center follow its internal control policies to ensure that formal documentation of review and approval is obtained and retained. Views of Responsible Officials – Management agrees with the finding.

Department of Health and Human Services Federal Financial Assistance Listing #93.332 Cooperative Agreement to Support Navigators in Federally-facilitated Exchanges Reporting Significant Deficiency in Internal Control over Compliance Criteria - 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition – There was no evidence retained that the Medical Center’s compliance and financial reports submitted to the Department of Health and Human Services were reviewed and approved prior to submission. Cause - The Medical Center did have an internal control policy in place to ensure documented review and approval of the compliance and financial reports was documented; however, this was not followed consistently throughout the year. Effect - The lack of adequate policies governing review and approval increases the risk that employees participating in the federal awards administration may not be able to detect and correct noncompliance in a timely manner. Questioned Costs - None Reported. Context/Sampling - A nonstatistical sample of 10 out of 69 reports were selected for detail testing and 5 did not include evidence of a review by someone other than the preparer. Repeat Finding from Prior Year(s) – Yes, 2022-002 Recommendation - We recommend the Medical Center follow its internal control policies to ensure that formal documentation of review and approval is obtained and retained. Views of Responsible Officials – Management agrees with the finding.