Audit 37711

FY End

2022-06-30

Total Expended

$11.56M

Findings

2

Programs

3

Organization: Eisenhower Medical Center (CA)

Year: 2022 Accepted: 2023-02-05

Auditor: Ernst & Young LLP

Organization Exclusion Status:

Checking exclusion status...

ID	Ref	Severity	Repeat	Requirement
30244	2022-001	Material Weakness	Yes	AB
606686	2022-001	Material Weakness	Yes	AB

ALN	Program	Spent	Major	Findings
93.498	Provider Relief Fund	$11.15M	Yes	1
93.732	Mental and Behavioral Health Education and Training Grants	$293,608	-	0
93.461	Covid-19 Testing for the Uninsured	$114,659	-	0

Contacts

Name	Title	Type
GMKNQX8NGV48	Melanie Long	Auditee
7608378699	Debra Kohnle	Auditor
No contacts on file

Notes to SEFA

Title: 3. Nature of Activities Accounting Policies: The accompanying schedule of expenditures of federal awards (the Schedule) includes the federal award activity of Eisenhower Medical Center under programs of the federal government for the year ended June 30, 2022. The information in this 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 (Uniform Guidance). Because the Schedule presents only a selected portion of the operations of Eisenhower Medical Center, it is not intended to and does not present the financial position, results of operations, changes in net assets, or cash flows of Eisenhower Medical Center. Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following, as applicable, the cost principles contained in the Uniform Guidance, 45 CFR, PART 75 APPENDIX IX, Principles for Determining Costs Applicable to Research and Development Under Grants and Contracts With Hospitals, wherein certain types of expenditures are not allowable or are limited as to reimbursement. Therefore, some amounts presented in the Schedule may differ from amounts presented in, or used in the preparation of, the consolidated financial statements. De Minimis Rate Used: N Rate Explanation: Eisenhower Medical Center has not elected to use the 10% de minimis indirect cost rate allowed under Uniform Guidance. Eisenhower Medical Center receives various grants to cover costs of specified programs. Final determination of eligibility of costs will be made by the grantors. Should any costs be found ineligible, Eisenhower Medical Center will be responsible for reimbursing the grantors for these amounts. Additionally, expenditures incurred for various programs may exceed the amounts awarded from the respective pass-through entity or agency. The amounts reported on the Schedule are limited to the award amounts. Amounts in excess of this amount are paid out of non-federal sources.

Title: 4. Provider Relief Fund Accounting Policies: The accompanying schedule of expenditures of federal awards (the Schedule) includes the federal award activity of Eisenhower Medical Center under programs of the federal government for the year ended June 30, 2022. The information in this 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 (Uniform Guidance). Because the Schedule presents only a selected portion of the operations of Eisenhower Medical Center, it is not intended to and does not present the financial position, results of operations, changes in net assets, or cash flows of Eisenhower Medical Center. Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following, as applicable, the cost principles contained in the Uniform Guidance, 45 CFR, PART 75 APPENDIX IX, Principles for Determining Costs Applicable to Research and Development Under Grants and Contracts With Hospitals, wherein certain types of expenditures are not allowable or are limited as to reimbursement. Therefore, some amounts presented in the Schedule may differ from amounts presented in, or used in the preparation of, the consolidated financial statements. De Minimis Rate Used: N Rate Explanation: Eisenhower Medical Center has not elected to use the 10% de minimis indirect cost rate allowed under Uniform Guidance. The amount presented on the SEFA for Assistance Listing Number 93.498, COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF Funds), is for the year ended June 30, 2022. The amount presented reconciles to the Provider Relief Fund (PRF) information reported to HRSA as follows: (see table in footnote). Health and Human Services (HHS) has indicated the PRF Funds on the SEFA be reported corresponding to reporting requirements of the HRSA PRF Reporting Portal. Payments from HHS for PRF are assigned to Payment Received Periods (each, a Period) based upon the date each payment from the PRF was received. Each Period has a specified Period of Availability and timing of reporting requirements. Entities report into the HRSA PRF Reporting Portal after each Periods deadline to use the funds (i.e., after the end of the Period of Availability). The SEFA includes $11,150,000 of PRF Funds received from HHS between July 1, 2020 through June 30, 2021. In accordance with guidance from HHS, these amounts are presented as Periods 2 and 3. Such amounts were recognized as other revenues in Eisenhower Medical Centers consolidated financial statements in the years ended June 30, 2021.

Finding Details

Finding 2022-001

Finding 2022-001 ? Internal Control Deficiency and Noncompliance over Activities Allowed or Unallowed and Allowable Costs Identification of the federal program: Federal Grantor: United States Department of Health and Human Services, Health Resources and Services Administration (HRSA) Assistance Listing No.: 93.498 Provider Relief Funds, COVID-19 ? Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Award Period of Performance: January 1, 2020 ? December 31, 2021 Criteria or Specific Requirement (including statutory, regulatory or other citation): Section 200.303 of the Uniform Guidance states the following regarding internal control: ?The non-Federal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition: The Company did not consistently retain documentation to evidence approval of expenses for certain disbursements to ensure expenses submitted for PRF were allowable COVID-19 related. Cause: The Company has a policy for paper requisitions to be moved off-site after two years. The Company was not able to locate the appropriate approval indicating the expenses are allowable COVID-19 related for such paper requisitions. Therefore, evidence of approval was not always retained. Effect or potential effect: A material weakness in internal controls over the activities allowed or unallowed, compliance requirements exist. There is no consistent documentation to support the performance of internal controls for accounts payable disbursements to ensure expenses submitted for PRF were allowable COVID-19 related. Questioned Costs: None Context: The Company had a pool of PRF related expenses that were eligible expenses that exceeded the total amount of PRF received. Total pool of PRF related expenditures was $17,237,519 for Assistance Listing 93.498, of which $7,597,704 were accounts payable disbursements. We selected 25 disbursements totaling $19,845 noting that 23 disbursements totaling $18,183 did not have evidence of proper approval. Identification as a repeat finding, if applicable: The finding is a repeat finding (2021-001). Recommendation: The Company should refine its process and retain documentation evidencing that management reviewed each expense submitted to HRSA and it qualified under the terms and conditions of the PRF program. View of Responsible Officials: The Company agrees with the finding.

Finding 2022-001

Finding 2022-001 ? Internal Control Deficiency and Noncompliance over Activities Allowed or Unallowed and Allowable Costs Identification of the federal program: Federal Grantor: United States Department of Health and Human Services, Health Resources and Services Administration (HRSA) Assistance Listing No.: 93.498 Provider Relief Funds, COVID-19 ? Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Award Period of Performance: January 1, 2020 ? December 31, 2021 Criteria or Specific Requirement (including statutory, regulatory or other citation): Section 200.303 of the Uniform Guidance states the following regarding internal control: ?The non-Federal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition: The Company did not consistently retain documentation to evidence approval of expenses for certain disbursements to ensure expenses submitted for PRF were allowable COVID-19 related. Cause: The Company has a policy for paper requisitions to be moved off-site after two years. The Company was not able to locate the appropriate approval indicating the expenses are allowable COVID-19 related for such paper requisitions. Therefore, evidence of approval was not always retained. Effect or potential effect: A material weakness in internal controls over the activities allowed or unallowed, compliance requirements exist. There is no consistent documentation to support the performance of internal controls for accounts payable disbursements to ensure expenses submitted for PRF were allowable COVID-19 related. Questioned Costs: None Context: The Company had a pool of PRF related expenses that were eligible expenses that exceeded the total amount of PRF received. Total pool of PRF related expenditures was $17,237,519 for Assistance Listing 93.498, of which $7,597,704 were accounts payable disbursements. We selected 25 disbursements totaling $19,845 noting that 23 disbursements totaling $18,183 did not have evidence of proper approval. Identification as a repeat finding, if applicable: The finding is a repeat finding (2021-001). Recommendation: The Company should refine its process and retain documentation evidencing that management reviewed each expense submitted to HRSA and it qualified under the terms and conditions of the PRF program. View of Responsible Officials: The Company agrees with the finding.