Audit 360576

Disaster Grants – Public Assistance (Presidentially Declared Disasters) Assistance Listing Number 97.036 Federal Emergency Management Agency Passed through Mississippi Emergency Management Agency Program Year 2023-2024 Criteria or Specific Requirement – Management is required to establish and maintain effective internal controls to ensure compliance with federal statues, regulations, and the terms and conditions of the federal award, including those related to Activities Allowed/Unallowed and Cost Principles (Pub. L. No. 116-136, 134 Stat. 563 and Pub. L. No. 116-139, 134 Stat. 622 and 623). Noncompliance with these requirements can result in questioned costs and reimbursement for ineligible expenditures. Condition – The Medical Center’s internal control over compliance allowed submission of expenses in which assistance from another source and expenses in which there was no underlying support. Cause – The Medical Center did not identify expenses reimbursed from other sources nor utilize medication cost formulas appropriate for the calculation of reimbursement amounts claimed and did not identify expenses that did not have support. Effect or Potential Effect – The Medical Center’s failure to determine expenditure reimbursement by other sources and unsupported expenses can lead to repayment of the grant award. Questioned Costs – Out of a population of 254 Disaster Grant expenses totaling $2,046,647 during the fiscal year ended September 30, 2024, Forvis Mazars selected a random sample of 40 expenses totaling $417,763 to test for compliance. Out of this sample of 40, 1 expense had activities with questioned costs of $4,496. This was not intended to be a statistically valid sample. In addition, discovered by the Medical Center, there were medications submitted as expenses billed to patients and formulas utilized in the calculation of COVID mediation costs which were not appropriately adjusted, allowing for potential questioned costs of $179,857. The questioned costs of $4,496 sampled above were also included in this amount. Additionally, $17,066 of costs were identified by the Medical Center as not being supported. The amount of total questioned costs is $196,923. Context – The Medical Center provided a listing of expenses which did not agree to the amount claimed on Disaster Grant submission, costs that were reimbursed by other sources, and potential over calculation of cost of COVID drugs included in submission. Prior Year Auditing Finding – N/A Recommendation – The Medical Center should implement a process to ensure adequate detail review of allowable expenses and possible reimbursement sources are in comparison to terms and conditions. Views of Responsible Officials and Planned Corrective Actions – Management concurs with the finding and will implement additional internal controls over the identification of eligible expenditures for the Disaster Grants program. Expenditures identified as potential grant program expenditures will be reviewed by the controller and final approval of each expense by the chief financial officer to ensure they are eligible expenses and have not been reimbursed by any other sources. We anticipate these additional controls to be in place by September 30. 2025. The Chief Development Officer will oversee the corrective action.

Disaster Grants – Public Assistance (Presidentially Declared Disasters) Assistance Listing Number 97.036 Federal Emergency Management Agency Passed through Mississippi Emergency Management Agency Program Year 2023-2024 Criteria or Specific Requirement – Management is required to establish and maintain effective internal controls to ensure compliance with federal statues, regulations, and the terms and conditions of the federal award, including those related to Activities Allowed/Unallowed and Cost Principles (Pub. L. No. 116-136, 134 Stat. 563 and Pub. L. No. 116-139, 134 Stat. 622 and 623). Noncompliance with these requirements can result in questioned costs and reimbursement for ineligible expenditures. Condition – The Medical Center’s internal control over compliance allowed submission of expenses in which assistance from another source and expenses in which there was no underlying support. Cause – The Medical Center did not identify expenses reimbursed from other sources nor utilize medication cost formulas appropriate for the calculation of reimbursement amounts claimed and did not identify expenses that did not have support. Effect or Potential Effect – The Medical Center’s failure to determine expenditure reimbursement by other sources and unsupported expenses can lead to repayment of the grant award. Questioned Costs – Out of a population of 254 Disaster Grant expenses totaling $2,046,647 during the fiscal year ended September 30, 2024, Forvis Mazars selected a random sample of 40 expenses totaling $417,763 to test for compliance. Out of this sample of 40, 1 expense had activities with questioned costs of $4,496. This was not intended to be a statistically valid sample. In addition, discovered by the Medical Center, there were medications submitted as expenses billed to patients and formulas utilized in the calculation of COVID mediation costs which were not appropriately adjusted, allowing for potential questioned costs of $179,857. The questioned costs of $4,496 sampled above were also included in this amount. Additionally, $17,066 of costs were identified by the Medical Center as not being supported. The amount of total questioned costs is $196,923. Context – The Medical Center provided a listing of expenses which did not agree to the amount claimed on Disaster Grant submission, costs that were reimbursed by other sources, and potential over calculation of cost of COVID drugs included in submission. Prior Year Auditing Finding – N/A Recommendation – The Medical Center should implement a process to ensure adequate detail review of allowable expenses and possible reimbursement sources are in comparison to terms and conditions. Views of Responsible Officials and Planned Corrective Actions – Management concurs with the finding and will implement additional internal controls over the identification of eligible expenditures for the Disaster Grants program. Expenditures identified as potential grant program expenditures will be reviewed by the controller and final approval of each expense by the chief financial officer to ensure they are eligible expenses and have not been reimbursed by any other sources. We anticipate these additional controls to be in place by September 30. 2025. The Chief Development Officer will oversee the corrective action.