Finding No: 2022-003 Federal Agency: U.S. Department of Health and Human Services Assistance Listing Number: 93.917 Program: HIV Care Formula Grants Compliance Requirement: Activities allowed or unallowed/allowable costs Award Year: January 1, 2022 through December 31, 2022 (a) Criteria or Requirement 2 CFR 200.303 requires non-federal entities receiving federal awards to establish and maintain internal controls designed to reasonably ensure compliance with federal laws, regulations, and program compliance requirements. Effective internal control should include procedures to ensure federal expenditures are accurately and completely reported on the SEFA. (b) Condition Found The System did not have adequate controls related to reporting expenditures for the HIV Care Formula Grant. Our testing identified 3 charges out of a sample of 43 that had been billed incorrectly to the granting agency. These charges were all for HIV-related care, consistent with the grant agreement, but were duplicate charges or other adjustments made to the billings that should have been adjusted prior to submission to the federal agency. (c) Cause The System has a review process in place to review all requests for reimbursement to the federal agency, including having a specific employee review all of these charges during the year. During the 2022 fiscal year, there was turnover within this position, resulting in an ineffective operation of the controls in place. (d) Effect Federal funds were expended for unallowable purposes or for inaccurate amounts and evidence of the effective operation of management review controls was not maintained in accordance with Federal requirements. (e) Questioned Cost None reportable (f) Statistical Sample Not applicable (g) Repeat Finding in the Prior Year Not a repeat finding (h) Recommendation (i) We recommend that the System strengthen controls over the management review process to prevent unallowable costs and inaccurate amounts from being charged to Federal programs. (j) View of Responsible Officials Invoices submitted to Mississippi State Department of Health (MSDH) for the HIV Care Formula Grants (CFDA No. 93.917) were reviewed by the clinic office manager prior to submission. There was no adequate assessment of all applicable patient charges in the invoice to MSDH. Of the 43 samples chosen for FY2022, there were 3 charges that were incorrectly submitted on an invoice to MSDH for reimbursement.
Finding No: 2022-001 Federal Agency: U.S. Department of Health and Human Services Assistance Listing Number: 93.155 Program: COVID- 19 Rural Health Research Centers Compliance Requirement: Other ? Inaccurate reporting of the Schedule of Expenditures of Federal Awards Award Year: July 1, 2021 through December 21, 2022 (a) Criteria or Requirement According to 2 CFR 200.510(b), a recipient of federal awards is required to prepare a schedule of expenditures of federal awards (SEFA) for the period covered by the entity?s financial statements which must include the total federal awards expended as determined in accordance with 2 CFR 200.502. Additionally, 2 CFR 200.303 requires non-federal entities receiving federal awards to establish and maintain internal controls designed to reasonably ensure compliance with federal laws, regulations, and program compliance requirements. Effective internal control should include procedures to ensure federal expenditures are accurately and completely reported on the SEFA. (b) Condition Found The System did not have adequate controls relating to reporting expenditures for the COVD-19 Rural Health Research Centers program on the SEFA. Specifically, the SEFA did not include $900,000 of expenditures incurred in the current fiscal year related to this program. The System corrected the SEFA and the program was subsequently determined to be a major program. (c) Cause The System has a review process in place to identify all federal grants and related expenditures. However, the review control in place was not designed to detect grants for which reimbursement had not been initially requested as of September 30, 2022 for expenditures incurred during the year ended September 30, 2022. (d) Effect Failure to establish effective internal controls over the preparation of the SEFA may prevent the System from reporting accurate program information and completing an audit in accordance with the Uniform Guidance. (e) Questioned Cost None (f) Statistical Sample Not applicable (g) Repeat Finding in the Prior Year Not a repeat finding (h) Recommendation We recommend that the System strengthen controls over the identification of all federal grants and related expenditures to ensure that all relevant amounts are appropriately captured on the SEFA during the year. (i) View of Responsible Officials Identification of all federal grants that were not awarded in the Fiscal Year of the SEFA was not a part of the analysis of completeness for the SEFA. In December 2021, Tishomingo Health Services, Clay County Medical Corporation, Pontotoc Health Services, Webster Health Services, and Marion Regional Medical Center entered into a sub-grant agreement with the COVID-19 Ship Program (CFDA No. 93.155) and incurred expenses believed to be applicable to the program in fiscal year 2022. Since no requests of grant funding was made in FY2022, the COVID-19 Ship Program (CFDA No. 93.155) was not included.
Finding No: 2022-002 Federal Agency: U.S. Department of Health and Human Services Assistance Listing Number: 93.697 Program: COVID- 19 Testing and Mitigation for Rural Health Clinics Compliance Requirement: Activities allowed or unallowed/allowable costs Award Year: January 1, 2021 through December 31, 2022 (a) Criteria or Requirement 2 CFR 200.303 requires non-federal entities receiving federal awards to establish and maintain internal controls designed to reasonably ensure compliance with federal laws, regulations, and program compliance requirements. (b) Condition Found The System did not have adequate controls related to reporting of laboratory expenditures specific to the number of COVID test kits. This reporting was utilized to determine the costs allowed for reimbursement under the program, resulting in 6 daily counts out of 28 selected samples containing errors, with a net overstatement of expenses of $2,000. (c) Cause The System?s review process in place over the recording of these costs did not operate effectively to prevent unallowable charges and inaccurate amounts from being submitted for reimbursement by the federal agency. (d) Effect Federal funds were expended for unallowable purposes or for inaccurate amounts and evidence of the effective operation of management review controls was not maintained in accordance with Federal requirements. (e) Questioned Cost None reportable (f) Statistical Sample Not applicable (g) Repeat Finding in the Prior Year Not a repeat finding (h) Recommendation We recommend that the System strengthen controls over the management review process to prevent unallowable costs and inaccurate amounts from being charged to Federal programs. (i) View of Responsible Officials The test kit counts for COVID-19 Testing and Mitigation for Rural Health Clinics (CFDA No. 93.697) reporting were generated through daily data analysis reports of Covid positive and negative resulted tests. The number of resulted tests were manually entered into a spreadsheet by lab personnel at North Mississippi Medical Clinics. The spreadsheet was used to assign the costs of the kits to each clinic where the resulted test occurred. Lab personnel did not consistently record accurate counts and did not perform a daily or monthly reconciliation to the generated data reports.
Finding No: 2022-003 Federal Agency: U.S. Department of Health and Human Services Assistance Listing Number: 93.917 Program: HIV Care Formula Grants Compliance Requirement: Activities allowed or unallowed/allowable costs Award Year: January 1, 2022 through December 31, 2022 (a) Criteria or Requirement 2 CFR 200.303 requires non-federal entities receiving federal awards to establish and maintain internal controls designed to reasonably ensure compliance with federal laws, regulations, and program compliance requirements. Effective internal control should include procedures to ensure federal expenditures are accurately and completely reported on the SEFA. (b) Condition Found The System did not have adequate controls related to reporting expenditures for the HIV Care Formula Grant. Our testing identified 3 charges out of a sample of 43 that had been billed incorrectly to the granting agency. These charges were all for HIV-related care, consistent with the grant agreement, but were duplicate charges or other adjustments made to the billings that should have been adjusted prior to submission to the federal agency. (c) Cause The System has a review process in place to review all requests for reimbursement to the federal agency, including having a specific employee review all of these charges during the year. During the 2022 fiscal year, there was turnover within this position, resulting in an ineffective operation of the controls in place. (d) Effect Federal funds were expended for unallowable purposes or for inaccurate amounts and evidence of the effective operation of management review controls was not maintained in accordance with Federal requirements. (e) Questioned Cost None reportable (f) Statistical Sample Not applicable (g) Repeat Finding in the Prior Year Not a repeat finding (h) Recommendation (i) We recommend that the System strengthen controls over the management review process to prevent unallowable costs and inaccurate amounts from being charged to Federal programs. (j) View of Responsible Officials Invoices submitted to Mississippi State Department of Health (MSDH) for the HIV Care Formula Grants (CFDA No. 93.917) were reviewed by the clinic office manager prior to submission. There was no adequate assessment of all applicable patient charges in the invoice to MSDH. Of the 43 samples chosen for FY2022, there were 3 charges that were incorrectly submitted on an invoice to MSDH for reimbursement.
Finding No: 2022-001 Federal Agency: U.S. Department of Health and Human Services Assistance Listing Number: 93.155 Program: COVID- 19 Rural Health Research Centers Compliance Requirement: Other ? Inaccurate reporting of the Schedule of Expenditures of Federal Awards Award Year: July 1, 2021 through December 21, 2022 (a) Criteria or Requirement According to 2 CFR 200.510(b), a recipient of federal awards is required to prepare a schedule of expenditures of federal awards (SEFA) for the period covered by the entity?s financial statements which must include the total federal awards expended as determined in accordance with 2 CFR 200.502. Additionally, 2 CFR 200.303 requires non-federal entities receiving federal awards to establish and maintain internal controls designed to reasonably ensure compliance with federal laws, regulations, and program compliance requirements. Effective internal control should include procedures to ensure federal expenditures are accurately and completely reported on the SEFA. (b) Condition Found The System did not have adequate controls relating to reporting expenditures for the COVD-19 Rural Health Research Centers program on the SEFA. Specifically, the SEFA did not include $900,000 of expenditures incurred in the current fiscal year related to this program. The System corrected the SEFA and the program was subsequently determined to be a major program. (c) Cause The System has a review process in place to identify all federal grants and related expenditures. However, the review control in place was not designed to detect grants for which reimbursement had not been initially requested as of September 30, 2022 for expenditures incurred during the year ended September 30, 2022. (d) Effect Failure to establish effective internal controls over the preparation of the SEFA may prevent the System from reporting accurate program information and completing an audit in accordance with the Uniform Guidance. (e) Questioned Cost None (f) Statistical Sample Not applicable (g) Repeat Finding in the Prior Year Not a repeat finding (h) Recommendation We recommend that the System strengthen controls over the identification of all federal grants and related expenditures to ensure that all relevant amounts are appropriately captured on the SEFA during the year. (i) View of Responsible Officials Identification of all federal grants that were not awarded in the Fiscal Year of the SEFA was not a part of the analysis of completeness for the SEFA. In December 2021, Tishomingo Health Services, Clay County Medical Corporation, Pontotoc Health Services, Webster Health Services, and Marion Regional Medical Center entered into a sub-grant agreement with the COVID-19 Ship Program (CFDA No. 93.155) and incurred expenses believed to be applicable to the program in fiscal year 2022. Since no requests of grant funding was made in FY2022, the COVID-19 Ship Program (CFDA No. 93.155) was not included.
Finding No: 2022-002 Federal Agency: U.S. Department of Health and Human Services Assistance Listing Number: 93.697 Program: COVID- 19 Testing and Mitigation for Rural Health Clinics Compliance Requirement: Activities allowed or unallowed/allowable costs Award Year: January 1, 2021 through December 31, 2022 (a) Criteria or Requirement 2 CFR 200.303 requires non-federal entities receiving federal awards to establish and maintain internal controls designed to reasonably ensure compliance with federal laws, regulations, and program compliance requirements. (b) Condition Found The System did not have adequate controls related to reporting of laboratory expenditures specific to the number of COVID test kits. This reporting was utilized to determine the costs allowed for reimbursement under the program, resulting in 6 daily counts out of 28 selected samples containing errors, with a net overstatement of expenses of $2,000. (c) Cause The System?s review process in place over the recording of these costs did not operate effectively to prevent unallowable charges and inaccurate amounts from being submitted for reimbursement by the federal agency. (d) Effect Federal funds were expended for unallowable purposes or for inaccurate amounts and evidence of the effective operation of management review controls was not maintained in accordance with Federal requirements. (e) Questioned Cost None reportable (f) Statistical Sample Not applicable (g) Repeat Finding in the Prior Year Not a repeat finding (h) Recommendation We recommend that the System strengthen controls over the management review process to prevent unallowable costs and inaccurate amounts from being charged to Federal programs. (i) View of Responsible Officials The test kit counts for COVID-19 Testing and Mitigation for Rural Health Clinics (CFDA No. 93.697) reporting were generated through daily data analysis reports of Covid positive and negative resulted tests. The number of resulted tests were manually entered into a spreadsheet by lab personnel at North Mississippi Medical Clinics. The spreadsheet was used to assign the costs of the kits to each clinic where the resulted test occurred. Lab personnel did not consistently record accurate counts and did not perform a daily or monthly reconciliation to the generated data reports.