FAC Explorer

Audit 34520

FY End
2022-06-30
Total Expended
$40.41M
Findings
2
Programs
32
Organization: Avera Health (SD)
Year: 2022 Accepted: 2023-03-27
Auditor: Eide Bailly LLP

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
39427 2022-002 Significant Deficiency Yes AB
615869 2022-002 Significant Deficiency Yes AB

Programs

ALN Program Spent Major Findings
93.498 Provider Relief Fund $24.29M Yes 0
93.461 Covid-19 Testing for the Uninsured $4.18M - 1
16.582 Crime Victim Assistance/discretionary Grants $914,017 - 0
93.279 Drug Abuse and Addiction Research Programs $541,134 - 0
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $472,079 - 0
97.030 Community Disaster Loans $351,980 - 0
93.393 Cancer Cause and Prevention Research $274,598 - 0
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $215,868 - 0
93.859 Biomedical Research and Research Training $209,825 - 0
16.589 Rural Domestic Violence, Dating Violence, Sexual Assault, and Stalking Assistance Program $200,931 - 0
20.509 Formula Grants for Rural Areas and Tribal Transit Program $172,486 - 0
93.211 Telehealth Programs $153,623 - 0
93.268 Immunization Cooperative Agreements $150,000 - 0
93.310 Trans-Nih Research Support $137,712 - 0
10.855 Distance Learning and Telemedicine Loans and Grants $118,171 - 0
10.525 Farm and Ranch Stress Assistance Network Competitive Grants Program (b) $100,000 - 0
93.837 Cardiovascular Diseases Research $98,205 - 0
93.395 Cancer Treatment Research $90,571 - 0
94.002 Retired and Senior Volunteer Program $90,244 - 0
21.027 Coronavirus State and Local Fiscal Recovery Funds $78,988 - 0
16.575 Crime Victim Assistance $47,000 - 0
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $45,441 - 0
93.838 Lung Diseases Research $39,896 - 0
93.301 Small Rural Hospital Improvement Grant Program $35,248 - 0
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $24,146 - 0
93.155 Rural Health Research Centers $15,534 - 0
93.994 Maternal and Child Health Services Block Grant to the States $11,823 - 0
93.889 National Bioterrorism Hospital Preparedness Program $11,804 - 0
93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research $6,644 - 0
20.513 Enhanced Mobility of Seniors and Individuals with Disabilities $6,302 - 0
93.243 Substance Abuse and Mental Health Services_projects of Regional and National Significance $3,468 - 0
93.069 Public Health Emergency Preparedness $1,664 - 0

Contacts

Name Title Type
N3MLDJDPQAA3 John Neth Auditee
6053224588 Ashley Brandt-Duda Auditor
No contacts on file

Notes to SEFA

Title: Basis of Presentation Accounting Policies: Expenditures reported in the schedule are reported on the accrual basis of accounting, with the exception for subrecipient expenditures and the COVID-19 Testing for the Uninsured Program, which are recorded based on when the claim is deemed eligible as evidenced by the receipt of monies from the federal agency. The COVID-19 Testing for the Uninsured Program expenditures are based upon receipt of monies from the federal agency. When applicable, 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. De Minimis Rate Used: Both Rate Explanation: Avera Health and Avera McKennan have negotiated indirect rates. All other sponsored organizations of the Organization have elected to use the 10% de minimis cost rate. The accompanying consolidated schedule of expenditures of federal awards (the schedule) includes the federal award activity of Avera Health (Organization) under programs of the federal government for the year ended June 30, 2022. The information 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 Organization, it is not intended to and does not present the consolidated balance sheet, consolidated statement of operations, consolidated changes in net assets or consolidated cash flows of the Organization.
Title: WIC Special Supplemental Nutrition Program for Women, Infants, and Children Accounting Policies: Expenditures reported in the schedule are reported on the accrual basis of accounting, with the exception for subrecipient expenditures and the COVID-19 Testing for the Uninsured Program, which are recorded based on when the claim is deemed eligible as evidenced by the receipt of monies from the federal agency. The COVID-19 Testing for the Uninsured Program expenditures are based upon receipt of monies from the federal agency. When applicable, 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. De Minimis Rate Used: Both Rate Explanation: Avera Health and Avera McKennan have negotiated indirect rates. All other sponsored organizations of the Organization have elected to use the 10% de minimis cost rate. Federal reimbursements for the WIC Special Supplemental Nutrition Program for Women, Infants, and Children, CFDA #10.557, are not based upon specific expenditures. Therefore, the amounts reported in the consolidated schedule of expenditures of federal awards represent cash received rather than federal expenditures.
Title: Principles of Consolidation Accounting Policies: Expenditures reported in the schedule are reported on the accrual basis of accounting, with the exception for subrecipient expenditures and the COVID-19 Testing for the Uninsured Program, which are recorded based on when the claim is deemed eligible as evidenced by the receipt of monies from the federal agency. The COVID-19 Testing for the Uninsured Program expenditures are based upon receipt of monies from the federal agency. When applicable, 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. De Minimis Rate Used: Both Rate Explanation: Avera Health and Avera McKennan have negotiated indirect rates. All other sponsored organizations of the Organization have elected to use the 10% de minimis cost rate. The consolidated schedule of expenditures of federal awards includes the federal grant activity of Avera Health and its consolidated subsidiaries (collectively, Avera Health) which received federal financial assistance. Significant intercompany balances and transactions have been eliminated in the consolidated schedule of expenditures of federal awards.The following entities and their associated TIN numbers included within the schedule are as follows: Avera At Home TIN#460399291, Avera Holy Family TIN#420680370, Avera Health TIN#460422673, Avera St. Anthonys TIN#470463911, Avera St. Benedicts TIN#460226738, Avera Sacred Heart Hospital TIN#460225483, Avera St. Lukes TIN#460224598, Avera St. Marys TIN#460230199, Avera Gettysburg TIN#460234354, Avera Granite Falls TIN#843156881, Avera McKennan TIN#460224743, Avera Marshall TIN#410919153, Avera Queen of Peace TIN#460224604, Avera Tyler TIN#410853163, and Heart Hospital of South Dakota TIN#562143771.
Title: Provider Relief Fund and American Rescue Plan Rural Distribution Accounting Policies: Expenditures reported in the schedule are reported on the accrual basis of accounting, with the exception for subrecipient expenditures and the COVID-19 Testing for the Uninsured Program, which are recorded based on when the claim is deemed eligible as evidenced by the receipt of monies from the federal agency. The COVID-19 Testing for the Uninsured Program expenditures are based upon receipt of monies from the federal agency. When applicable, 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. De Minimis Rate Used: Both Rate Explanation: Avera Health and Avera McKennan have negotiated indirect rates. All other sponsored organizations of the Organization have elected to use the 10% de minimis cost rate. The Organization received amounts from the U.S. Department of Health and Human Services (HHS) through the Provider Relief Fund and American Rescue Plan Rural Distribution (PRF) program (Federal Financial Assistance Listing/CFDA #93.498) during the years ended June 30, 2022 and 2021, and 2020. The PRF expenditures were not recognized on the schedule until the expenditures were included in the reporting to HHS for the funds received between July 1, 2020 and June 30, 2021, as required under the PRF program. The Organization recorded $24,493,315 of Provider Relief Funds and American Rescue Plan Rural Distribution Funds on the Schedule of Expenditures of Federal Awards as of June 30, 2022.

Finding Details

Finding 2022-002
2022-002 Department of Health and Human Services CFDA #93.461 COVID-19 Uninsured COVID Testing and Treatment Activities Allowed and Allowable Costs Significant Deficiency in Internal Control over Compliance and Noncompliance 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: Our testing over activities allowed and allowable costs identified three instances in which patient treatment charges were charged under federal award and COVID-19 was not the primary diagnosis. Cause: There was a lapse in oversight of the internal control process ensuring patient treatment costs without a COVID-19 primary diagnosis were not charged to the federal award. Effect: The Organization?s controls did not detect or correct the errors identified, which resulted in disallowed costs being submitted under the federal award. Questioned Costs: $264 Context: A non-statistical sample of 60 transactions was selected for testing, which accounted for $29,916 of $4,184,833 of federal program expenditures. Repeat Finding from Prior Year: Yes Recommendation: We recommend the Organization review and strengthen the controls surrounding the patient eligibility and billing. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-002
2022-002 Department of Health and Human Services CFDA #93.461 COVID-19 Uninsured COVID Testing and Treatment Activities Allowed and Allowable Costs Significant Deficiency in Internal Control over Compliance and Noncompliance 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: Our testing over activities allowed and allowable costs identified three instances in which patient treatment charges were charged under federal award and COVID-19 was not the primary diagnosis. Cause: There was a lapse in oversight of the internal control process ensuring patient treatment costs without a COVID-19 primary diagnosis were not charged to the federal award. Effect: The Organization?s controls did not detect or correct the errors identified, which resulted in disallowed costs being submitted under the federal award. Questioned Costs: $264 Context: A non-statistical sample of 60 transactions was selected for testing, which accounted for $29,916 of $4,184,833 of federal program expenditures. Repeat Finding from Prior Year: Yes Recommendation: We recommend the Organization review and strengthen the controls surrounding the patient eligibility and billing. Views of Responsible Officials: Management agrees with the finding.