Audit 46814

FY End
2022-09-30
Total Expended
$17.47M
Findings
4
Programs
7
Year: 2022 Accepted: 2023-09-25

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
50926 2022-002 Material Weakness Yes L
50927 2022-003 Material Weakness - N
627368 2022-002 Material Weakness Yes L
627369 2022-003 Material Weakness - N

Contacts

Name Title Type
S277U1C5C6N6 Tom Bailey Auditee
9048194069 Adam Stevenson Auditor
No contacts on file

Notes to SEFA

Accounting Policies: The accompanying schedule of expenditures of federal awards includes the federal grant activity of Flagler Hospital, Inc. and Subsidiaries dba Flagler Health+ (the System) under programs of the federal government for the year ended September 30, 2022. The information in the schedule of expenditures of federal awards 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). The accompanying schedule of expenditures of state financial assistance projects includes the state project activity of the System under programs of the state government for the year ended September 30, 2022. The information in the schedule of expenditures of state financial assistance projects is presented in accordance with the requirements of the Florida Single Audit Act and Chapter 10.650 of the Rules of the Auditor General. Because the schedule of expenditures of federal awards and schedule of expenditures of state financial assistance projects present only a selected portion of the operations of the System, it is not intended to and does not present the financial position, changes in net assets, or cash flows of the System. Expenditures reported in the schedule of expenditures of federal awards and schedule of expenditures of state financial assistance projects 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; the Florida Single Audit Act; or Chapter 10.650 of the Rules of the Auditor General wherein certain types of expenditures are not allowable or are limited as to reimbursement, except for expenditures related to Assistance Listing Number (ALN) 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF). 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' (HHS) guidance and frequently asked questions, as outlined in the Compliance Supplement. For the PRF program, HHS has indicated that the amounts on the schedules 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 specific period of availability and timing of reporting requirements. The pass through entity identifying numbers are presented where available.The System 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

Assistance Listing Number, Federal Agency, and Program Name ? 93.498, U.S. Department of Health and Human Services, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF) Federal Award Identification Number and Year ? N/A, 2022 Pass-through Entity ? N/A ? Direct funded Finding Type ? Material weakness and material noncompliance with laws and regulations Repeat Finding ? Yes; 2021-001 Criteria ? per the Provider Relief Fund General and Targeted Distributions Post-Payment Notice of Reporting Requirements dated June 11, 2021, recipients may choose to apply PRF payments toward lost revenue using one of three options, up to the amount: Option i: of the difference between actual patient care revenue; Option ii: of the difference between budgeted (prior to March 27, 2020) and actual patient care revenue; or Option iii: calculated by any reasonable method of estimating revenue The same Post-Payment Notice of Reporting Requirements included specific submission deadlines for PRF portal submissions. Period 2 submissions were due by March 31, 2022 and Period 3 submissions were due by September 30, 2022. Condition ? The System?s controls in place for reporting submissions did not identify that guidelines were not followed related to the lost revenue calculations or the required submission timeline. Questioned Costs ? None Identification of How Questioned Costs Were Computed ? N/A ? Refer to context below for additional information. Context ? The Period 2 reporting submission for lost revenue did not follow the acceptable options provided by the Department of Health and Human Services. Recipients may choose to apply Provider Relief Fund payments toward lost revenue using one of three options: (i) up to the amount of the difference between actual patient care revenue, (ii) up to the amount of the difference between budgeted (if approved prior to March 27, 2020) and actual patient care revenue, or (iii) up to the amount calculated by any reasonable method of estimating revenue. The System used option ii to calculate lost revenue but the budgeted amounts used in the submission for several periods were not approved by March 27, 2020; therefore, option ii was not allowable. The System should have used option iii to report lost revenue. Additionally, the Period 2 submission was submitted late; it was due by March 31, 2022 but was not submitted until June 14, 2022. Cause and Effect ? Appropriate review of the reporting submission was not completed to ensure the report followed the required guidelines. As a result, the report submitted was inaccurate and late. Recommendation - We recommend the System implement controls, including levels of review, to ensure reports are completed and submitted in accordance with the guidelines established by HHS. Views of Responsible Officials and Planned Corrective Actions ? The System will review and enhance its PRF reporting process by implementing controls to ensure reports are completed and submitted in accordance with the guidelines established by HHS.
Assistance Listing Number, Federal Agency, and Program Name ? 14.231, U.S. Department of Housing and Urban Development, Emergency Solutions Grants Program Federal Award Identification Number and Year ? N/A, 2022 Pass-through Entity ? Florida Department of Children and Families Finding Type ? Material weakness and material noncompliance with laws and regulations Repeat Finding ? No Criteria ? Award recipients must pay each subrecipient for allowable costs within 30 days after receiving the subrecipient?s complete payment request. Condition ? The System?s controls in place for subrecipient payments did not ensure that subrecipients were paid within the required 30 day window. Questioned Costs ? None Identification of How Questioned Costs Were Computed ? N/A ? Refer to context below for additional information. Context ? A total of 18 payments to subrecipients were tested. One selection was paid 52 days after the System received the subrecipient?s complete payment request; all other payments were made within the 30 day window. Cause and Effect ? The program regulations mandate timely remittance of payments. The controls designed to adhere to that requirement were not operating effectively in the instance identified in our testing. As a result, the System did not comply with the 30 day payment window requirement for payments to subrecipients. Recommendation - We recommend the System implement controls, including levels of review, to ensure grant agreements are thoroughly reviewed to understand all compliance requirements. Views of Responsible Officials and Planned Corrective Actions ? The System will review and enhance its grant agreement review process by implementing controls to ensure grant agreements are thoroughly reviewed and are adhering to all the compliance requirements.
Assistance Listing Number, Federal Agency, and Program Name ? 93.498, U.S. Department of Health and Human Services, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF) Federal Award Identification Number and Year ? N/A, 2022 Pass-through Entity ? N/A ? Direct funded Finding Type ? Material weakness and material noncompliance with laws and regulations Repeat Finding ? Yes; 2021-001 Criteria ? per the Provider Relief Fund General and Targeted Distributions Post-Payment Notice of Reporting Requirements dated June 11, 2021, recipients may choose to apply PRF payments toward lost revenue using one of three options, up to the amount: Option i: of the difference between actual patient care revenue; Option ii: of the difference between budgeted (prior to March 27, 2020) and actual patient care revenue; or Option iii: calculated by any reasonable method of estimating revenue The same Post-Payment Notice of Reporting Requirements included specific submission deadlines for PRF portal submissions. Period 2 submissions were due by March 31, 2022 and Period 3 submissions were due by September 30, 2022. Condition ? The System?s controls in place for reporting submissions did not identify that guidelines were not followed related to the lost revenue calculations or the required submission timeline. Questioned Costs ? None Identification of How Questioned Costs Were Computed ? N/A ? Refer to context below for additional information. Context ? The Period 2 reporting submission for lost revenue did not follow the acceptable options provided by the Department of Health and Human Services. Recipients may choose to apply Provider Relief Fund payments toward lost revenue using one of three options: (i) up to the amount of the difference between actual patient care revenue, (ii) up to the amount of the difference between budgeted (if approved prior to March 27, 2020) and actual patient care revenue, or (iii) up to the amount calculated by any reasonable method of estimating revenue. The System used option ii to calculate lost revenue but the budgeted amounts used in the submission for several periods were not approved by March 27, 2020; therefore, option ii was not allowable. The System should have used option iii to report lost revenue. Additionally, the Period 2 submission was submitted late; it was due by March 31, 2022 but was not submitted until June 14, 2022. Cause and Effect ? Appropriate review of the reporting submission was not completed to ensure the report followed the required guidelines. As a result, the report submitted was inaccurate and late. Recommendation - We recommend the System implement controls, including levels of review, to ensure reports are completed and submitted in accordance with the guidelines established by HHS. Views of Responsible Officials and Planned Corrective Actions ? The System will review and enhance its PRF reporting process by implementing controls to ensure reports are completed and submitted in accordance with the guidelines established by HHS.
Assistance Listing Number, Federal Agency, and Program Name ? 14.231, U.S. Department of Housing and Urban Development, Emergency Solutions Grants Program Federal Award Identification Number and Year ? N/A, 2022 Pass-through Entity ? Florida Department of Children and Families Finding Type ? Material weakness and material noncompliance with laws and regulations Repeat Finding ? No Criteria ? Award recipients must pay each subrecipient for allowable costs within 30 days after receiving the subrecipient?s complete payment request. Condition ? The System?s controls in place for subrecipient payments did not ensure that subrecipients were paid within the required 30 day window. Questioned Costs ? None Identification of How Questioned Costs Were Computed ? N/A ? Refer to context below for additional information. Context ? A total of 18 payments to subrecipients were tested. One selection was paid 52 days after the System received the subrecipient?s complete payment request; all other payments were made within the 30 day window. Cause and Effect ? The program regulations mandate timely remittance of payments. The controls designed to adhere to that requirement were not operating effectively in the instance identified in our testing. As a result, the System did not comply with the 30 day payment window requirement for payments to subrecipients. Recommendation - We recommend the System implement controls, including levels of review, to ensure grant agreements are thoroughly reviewed to understand all compliance requirements. Views of Responsible Officials and Planned Corrective Actions ? The System will review and enhance its grant agreement review process by implementing controls to ensure grant agreements are thoroughly reviewed and are adhering to all the compliance requirements.