FAC Explorer

Audit 46463

FY End
2022-09-30
Total Expended
$14.60M
Findings
4
Programs
4
Organization: Wakemed (NC)
Year: 2022 Accepted: 2023-06-25
Auditor: Plante & Moran PLLC

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
46421 2022-001 Significant Deficiency - L
46422 2022-002 Significant Deficiency Yes A
622863 2022-001 Significant Deficiency - L
622864 2022-002 Significant Deficiency Yes A

Programs

ALN Program Spent Major Findings
93.498 Covid-19- Provider Relief Fund and American Rescue Plan Rural Distribution $10.90M Yes 1
93.461 Covid-19 Claims Reimbursement for the Uninsured Program and the Covid-19 Coverage Assistance Fund $3.36M Yes 1
14.218 Community Development Block Grants/entitlement Grants $190,937 - 0
93.107 Area Health Education Centers Point of Service Maintenance and Enhancement Awards $151,063 - 0

Contacts

Name Title Type
FRMNXEUG7DY9 Stephanie Sessoms Auditee
9193508000 Oliver Jurkovic Auditor
No contacts on file

Notes to SEFA

Accounting Policies: The accompanying schedule of expenditures of federal awards (the "Schedule") includes the federal grant activity of WakeMed under programs of the federal government for the year ended September 30, 2022. The information in the 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 (the "Uniform Guidance"). Because the Schedule presents only a selected portion of the operations of WakeMed, it is not intended to and does not present the financial position, changes in net position, or cash flows of WakeMed. Expenditures reported in the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, wherein certain types of expenditures are not allowable or are limited as to reimbursement except for expenditures related to Assistance Listing Number 93.498, Provider Relief Fund (PRF) and American Rescue Plan Rural Distribution. PRF does not apply the cost principles contained in Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, but rather applies the U.S. Department of Health and Human Services guidance and frequently asked questions, as outlined in the Compliance Supplement. For the PRF program, HHS has indicated that the amounts on the Schedule should be reported in correspondence with reporting requirements of the HHS PRF Reporting Portal. Payments from HHS for PRF are assigned to one of five payment received periods based upon the date each PRF payment was received. Each period has a specified period of availability and timing of reporting requirements. The pass through entity identifying numbers are presented where available.WakeMed has elected not to use the 10 percent de minimis indirect cost rate to recover indirect costs, as allowed under the Uniform Guidance. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate.

Finding Details

Finding 2022-001
Assistance Listing Number, Federal Agency, and Program Name 93.498, Department of Health and Human Services, Provider Relief Fund and American Rescue Plan Rural Distribution Federal Award Identification Number and Year N/A Pass through Entity N/A Finding Type Significant deficiency Repeat Finding No Criteria According to the Post Payment Notice of Reporting Requirements issued by the U.S. Department of Health and Human Services (HHS) dated October 7, 2022, the reporting entity must report on expenses paid for with payments received through the general and targeted distribution payments. Such expenses must be those that another source has not reimbursed and is not obligated to reimburse. HRSA considers unreimbursed expenses attributable to COVID 19 first in the overall use of funds calculation. Condition WakeMed reported duplicate expenditures within the Period 2 portal submission. Questioned Costs None Identification of How Questioned Costs Were Computed None Context WakeMed entered expenditures totaling $941,790 into the Period 1 portal submission. WakeMed then reported the same expenditures into the Period 2 portal submission. Cause and Effect Management misunderstood the functionality of the reporting portal site and reported the same expenses from Period 1 into the Period 2 portal submission. The duplicate expenses reported in Period 2 were improperly applied against Period 2 funding received, and as a result, lost revenues used in determining the total provider relief funding earned were improperly calculated. Recommendation Management should review all reporting requirements for the grant prior to submission of required reports.
Finding 2022-002
2022 002 Assistance Listing Number, Federal Agency, and Program Name 93.461, Department of Health and Human Services, COVID 19 Claims Reimbursement for the Uninsured Program and the COVID 19 Coverage Assistance Fund Federal Award Identification Number and Year N/A Pass through Entity N/A Finding Type Significant deficiency Repeat Finding Yes Prior year finding number: 2021 001 Criteria The COVID 19 Claims Reimbursement for the Uninsured Program and the COVID 19 Coverage Assistance Fund grant is to be used for "reimbursement of payment for COVID 19 testing and testing related items for individuals who do not have coverage through an individual or employer sponsored plan," per the 2022 Compliance Supplement. Condition WakeMed charged costs associated with ineligible individuals to the grant. Questioned Costs None Identification of How Questioned Costs Were Computed N/A Context During testing of 60 patients, we identified one patient who should not have been submitted to HRSA for reimbursement, as they were covered by insurance and, therefore, ineligible. The ineligible cost was removed from the SEFA and is in the process of being refunded to HRSA. Cause and Effect While WakeMed had a process in place to review individuals for eligibility prior to claims being submitted, there was no process to subsequently evaluate changes in insurance status that may result in the patient being ineligible for the program. Recommendation WakeMed should have a process in place to review and identify claims in which insurance status may have changed, in which refunds need to be issued to HRSA.
Finding 2022-001
Assistance Listing Number, Federal Agency, and Program Name 93.498, Department of Health and Human Services, Provider Relief Fund and American Rescue Plan Rural Distribution Federal Award Identification Number and Year N/A Pass through Entity N/A Finding Type Significant deficiency Repeat Finding No Criteria According to the Post Payment Notice of Reporting Requirements issued by the U.S. Department of Health and Human Services (HHS) dated October 7, 2022, the reporting entity must report on expenses paid for with payments received through the general and targeted distribution payments. Such expenses must be those that another source has not reimbursed and is not obligated to reimburse. HRSA considers unreimbursed expenses attributable to COVID 19 first in the overall use of funds calculation. Condition WakeMed reported duplicate expenditures within the Period 2 portal submission. Questioned Costs None Identification of How Questioned Costs Were Computed None Context WakeMed entered expenditures totaling $941,790 into the Period 1 portal submission. WakeMed then reported the same expenditures into the Period 2 portal submission. Cause and Effect Management misunderstood the functionality of the reporting portal site and reported the same expenses from Period 1 into the Period 2 portal submission. The duplicate expenses reported in Period 2 were improperly applied against Period 2 funding received, and as a result, lost revenues used in determining the total provider relief funding earned were improperly calculated. Recommendation Management should review all reporting requirements for the grant prior to submission of required reports.
Finding 2022-002
2022 002 Assistance Listing Number, Federal Agency, and Program Name 93.461, Department of Health and Human Services, COVID 19 Claims Reimbursement for the Uninsured Program and the COVID 19 Coverage Assistance Fund Federal Award Identification Number and Year N/A Pass through Entity N/A Finding Type Significant deficiency Repeat Finding Yes Prior year finding number: 2021 001 Criteria The COVID 19 Claims Reimbursement for the Uninsured Program and the COVID 19 Coverage Assistance Fund grant is to be used for "reimbursement of payment for COVID 19 testing and testing related items for individuals who do not have coverage through an individual or employer sponsored plan," per the 2022 Compliance Supplement. Condition WakeMed charged costs associated with ineligible individuals to the grant. Questioned Costs None Identification of How Questioned Costs Were Computed N/A Context During testing of 60 patients, we identified one patient who should not have been submitted to HRSA for reimbursement, as they were covered by insurance and, therefore, ineligible. The ineligible cost was removed from the SEFA and is in the process of being refunded to HRSA. Cause and Effect While WakeMed had a process in place to review individuals for eligibility prior to claims being submitted, there was no process to subsequently evaluate changes in insurance status that may result in the patient being ineligible for the program. Recommendation WakeMed should have a process in place to review and identify claims in which insurance status may have changed, in which refunds need to be issued to HRSA.