FAC Explorer

Audit 40813

FY End
2022-06-30
Total Expended
$9.69M
Findings
6
Programs
7
Organization: Monument Health, Inc. (SD)
Year: 2022 Accepted: 2023-03-29
Auditor: Eide Bailly LLP

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
48233 2022-001 Material Weakness - P
48234 2022-002 Significant Deficiency - AB
48235 2022-001 Material Weakness - P
624675 2022-001 Material Weakness - P
624676 2022-002 Significant Deficiency - AB
624677 2022-001 Material Weakness - P

Programs

ALN Program Spent Major Findings
93.498 Provider Relief Fund $4.91M Yes 1
93.461 Covid-19 Testing for the Uninsured $4.34M Yes 2
93.103 Food and Drug Administration_research $254,780 - 0
93.217 Family Planning_services $95,980 - 0
93.301 Small Rural Hospital Improvement Grant Program $51,344 - 0
93.697 Covid-19 Testing for Rural Health Clinics $30,065 - 0
93.268 Immunization Cooperative Agreements $6,125 - 0

Contacts

Name Title Type
LFK8DDLYRHL6 Mark Thompson Auditee
6057559127 Joy Feige Auditor
No contacts on file

Notes to SEFA

Title: Basis of Presentation Accounting Policies: Expenditures reported on the schedule are reported on the accrual basis of accounting, with the exception for the COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund (Uninsured Program), are based on when the claim is determined eligible evidenced by the 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. No federal financial assistance has been provided to a subrecipient. De Minimis Rate Used: N Rate Explanation: Monument Health has not 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 Monument Health, Inc. and its consolidated subsidiaries (collectively, Monument Health) under programs of the federal government for the year ended June 30, 2022. The information is presented inaccordance 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 Monument Health, it is not intended to and does not present the financial position, changes in net position, or cash flows of Monument Health.
Title: Principles of Consolidation Accounting Policies: Expenditures reported on the schedule are reported on the accrual basis of accounting, with the exception for the COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund (Uninsured Program), are based on when the claim is determined eligible evidenced by the 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. No federal financial assistance has been provided to a subrecipient. De Minimis Rate Used: N Rate Explanation: Monument Health has not elected to use the 10% de minimis cost rate. The consolidated schedule of expenditures of federal awards includes the federal grant activity of Monument Health, Inc. and its consolidated subsidiaries (collectively, Monument 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: Monument Health Rapid City Hospital, Inc. TIN#460319070 and Monument Health Network, Inc. TIN#460360899.
Title: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Accounting Policies: Expenditures reported on the schedule are reported on the accrual basis of accounting, with the exception for the COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund (Uninsured Program), are based on when the claim is determined eligible evidenced by the 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. No federal financial assistance has been provided to a subrecipient. De Minimis Rate Used: N Rate Explanation: Monument Health has not elected to use the 10% de minimis cost rate. Monument Health received amounts from the U.S. Department of Health and Human Services (HHS) through the Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF) program (Federal Financial Assistance Listing #93.498) in the amount of $61,950,784 as of June 30, 2022. PRF expenditures are not recognized on the schedule until the expenditures were included in the reporting to HHS as required under the PRF program.The following summarizes the Provider Relief Funds and the timing of when the amounts were recognized in the consolidated financial statements.(see table in report)

Finding Details

Finding 2022-001
2022-001 Department of Health and Human Services Federal Financial Assistance Listing #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 2 TIN#460319070, and TIN#460360899 Federal Financial Assistance Listing #93.461 COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Preparation of the Consolidated Schedule of Expenditures of Federal Awards Material Weakness in Internal Control over Compliance - Other Criteria: Proper controls over financial reporting include the ability to prepare the consolidated schedule of expenditures of federal awards (the schedule) and the accompanying notes to the schedule. Condition: Management prepared the schedule for the year ended June 30, 2022. During testing, the auditors decreased the amount reported for the COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution program (PRF) to the amounts reported within the Department of Health and Human Services (HHS) for Period 2 and Period 3 Special Report. In addition, adjustments were made to decrease the amount reported for the COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund (Uninsured Program) to total receipt of monies received from the federal agency during the year ended June 30, 2022. Cause: The amount reported for PRF included the amount of funds received during Period 4. In addition, the Uninsured program improperly included monies from the federal agency with deposit dates during June 2021 and improperly excluded monies from the federal agency with deposit dates during June 2022. Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements and preparation is only required when Monument Health meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that Monument Health would not be able to draft a complete and accurate schedule without the assistance of the auditors. Questioned Costs: None reported. Context: Sampling was not used. Repeat Finding from Prior Years: No Recommendation: We recommend that management review the unique requirements of the PRF program relating to when the expenditures are required to reported on the schedule. In addition, we recommend reviewing grant expenditures near year end to ensure proper cut-off relating to claims paid under the Uninsured Program. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-002
2022-002 Department of Health and Human Services Federal Financial Assistance Listing #93.461 COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Activities Allowed or Unallowed and Allowable Costs/Cost Principles 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: Our testing identified one instance in which health services provided to a patient were reimbursed under the federal program, and the health services provided did not meet the terms and conditions of the federal program. Cause: Through the coding process, an incorrect Dx Code was included in the system, and therefore, the patient?s health services flowed into Monument Health?s Uninsured Program workflow which resulted in $3,563 of health services being reimbursed under the federal program. Effect: Funds were received under the federal program for health services provided which did not meet the terms and conditions of the federal program. Questioned Costs: None reported. Context: A non-statistical sample of 60 patients were selected for testing, which accounted for $1,659,497 of $4,344,728 of monies received from the federal agency. Repeat Finding from Prior Years: No Recommendation: We recommend management review health services provided to patients to ensure the health services provided are allowable to be reimbursed under the terms and conditions of the federal program. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-001
2022-001 Department of Health and Human Services Federal Financial Assistance Listing #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 2 TIN#460319070, and TIN#460360899 Federal Financial Assistance Listing #93.461 COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Preparation of the Consolidated Schedule of Expenditures of Federal Awards Material Weakness in Internal Control over Compliance - Other Criteria: Proper controls over financial reporting include the ability to prepare the consolidated schedule of expenditures of federal awards (the schedule) and the accompanying notes to the schedule. Condition: Management prepared the schedule for the year ended June 30, 2022. During testing, the auditors decreased the amount reported for the COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution program (PRF) to the amounts reported within the Department of Health and Human Services (HHS) for Period 2 and Period 3 Special Report. In addition, adjustments were made to decrease the amount reported for the COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund (Uninsured Program) to total receipt of monies received from the federal agency during the year ended June 30, 2022. Cause: The amount reported for PRF included the amount of funds received during Period 4. In addition, the Uninsured program improperly included monies from the federal agency with deposit dates during June 2021 and improperly excluded monies from the federal agency with deposit dates during June 2022. Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements and preparation is only required when Monument Health meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that Monument Health would not be able to draft a complete and accurate schedule without the assistance of the auditors. Questioned Costs: None reported. Context: Sampling was not used. Repeat Finding from Prior Years: No Recommendation: We recommend that management review the unique requirements of the PRF program relating to when the expenditures are required to reported on the schedule. In addition, we recommend reviewing grant expenditures near year end to ensure proper cut-off relating to claims paid under the Uninsured Program. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-001
2022-001 Department of Health and Human Services Federal Financial Assistance Listing #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 2 TIN#460319070, and TIN#460360899 Federal Financial Assistance Listing #93.461 COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Preparation of the Consolidated Schedule of Expenditures of Federal Awards Material Weakness in Internal Control over Compliance - Other Criteria: Proper controls over financial reporting include the ability to prepare the consolidated schedule of expenditures of federal awards (the schedule) and the accompanying notes to the schedule. Condition: Management prepared the schedule for the year ended June 30, 2022. During testing, the auditors decreased the amount reported for the COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution program (PRF) to the amounts reported within the Department of Health and Human Services (HHS) for Period 2 and Period 3 Special Report. In addition, adjustments were made to decrease the amount reported for the COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund (Uninsured Program) to total receipt of monies received from the federal agency during the year ended June 30, 2022. Cause: The amount reported for PRF included the amount of funds received during Period 4. In addition, the Uninsured program improperly included monies from the federal agency with deposit dates during June 2021 and improperly excluded monies from the federal agency with deposit dates during June 2022. Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements and preparation is only required when Monument Health meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that Monument Health would not be able to draft a complete and accurate schedule without the assistance of the auditors. Questioned Costs: None reported. Context: Sampling was not used. Repeat Finding from Prior Years: No Recommendation: We recommend that management review the unique requirements of the PRF program relating to when the expenditures are required to reported on the schedule. In addition, we recommend reviewing grant expenditures near year end to ensure proper cut-off relating to claims paid under the Uninsured Program. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-002
2022-002 Department of Health and Human Services Federal Financial Assistance Listing #93.461 COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Activities Allowed or Unallowed and Allowable Costs/Cost Principles 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: Our testing identified one instance in which health services provided to a patient were reimbursed under the federal program, and the health services provided did not meet the terms and conditions of the federal program. Cause: Through the coding process, an incorrect Dx Code was included in the system, and therefore, the patient?s health services flowed into Monument Health?s Uninsured Program workflow which resulted in $3,563 of health services being reimbursed under the federal program. Effect: Funds were received under the federal program for health services provided which did not meet the terms and conditions of the federal program. Questioned Costs: None reported. Context: A non-statistical sample of 60 patients were selected for testing, which accounted for $1,659,497 of $4,344,728 of monies received from the federal agency. Repeat Finding from Prior Years: No Recommendation: We recommend management review health services provided to patients to ensure the health services provided are allowable to be reimbursed under the terms and conditions of the federal program. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-001
2022-001 Department of Health and Human Services Federal Financial Assistance Listing #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 2 TIN#460319070, and TIN#460360899 Federal Financial Assistance Listing #93.461 COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Preparation of the Consolidated Schedule of Expenditures of Federal Awards Material Weakness in Internal Control over Compliance - Other Criteria: Proper controls over financial reporting include the ability to prepare the consolidated schedule of expenditures of federal awards (the schedule) and the accompanying notes to the schedule. Condition: Management prepared the schedule for the year ended June 30, 2022. During testing, the auditors decreased the amount reported for the COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution program (PRF) to the amounts reported within the Department of Health and Human Services (HHS) for Period 2 and Period 3 Special Report. In addition, adjustments were made to decrease the amount reported for the COVID-19 HRSA Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund (Uninsured Program) to total receipt of monies received from the federal agency during the year ended June 30, 2022. Cause: The amount reported for PRF included the amount of funds received during Period 4. In addition, the Uninsured program improperly included monies from the federal agency with deposit dates during June 2021 and improperly excluded monies from the federal agency with deposit dates during June 2022. Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements and preparation is only required when Monument Health meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that Monument Health would not be able to draft a complete and accurate schedule without the assistance of the auditors. Questioned Costs: None reported. Context: Sampling was not used. Repeat Finding from Prior Years: No Recommendation: We recommend that management review the unique requirements of the PRF program relating to when the expenditures are required to reported on the schedule. In addition, we recommend reviewing grant expenditures near year end to ensure proper cut-off relating to claims paid under the Uninsured Program. Views of Responsible Officials: Management agrees with the finding.