Audit 6053

Federal Program Information Federal Agency: U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) Award: Assistance Listing Number 93.461 COVID-19 - HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Award Period: February 4, 2020 - Ongoing Description: Timely Preparation of Schedule of Expenditures of Federal Awards Type of Finding: Material Weakness in Internal Control Over Compliance Criteria or specific requirement (including statutory, regulatory or other citation) In accordance with Title 2 U.S. Code of Federal Regulations, Part 200.303, Internal controls, “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 System had not developed a formal process to prepare and review its Schedule of Expenditures of Federal Awards and was not able to complete the Schedule for the year ended June 30, 2020 in a timely manner. Cause During the year ended June 30, 2020, the System was required to prepare the Schedule for the first time since its expenditures exceeded $750,000. This was primarily due to a new grant that arose suddenly in response to treating Covid-19 patients. Consequently, the System had not identified individuals with the appropriate knowledge and training to prepare the Schedule for this fiscal period. This also occurred as a result of Covid-19 which impacted the availability of resources due to the challenges presented to the System which were unexpected and strained existing resources and the ability to hire new resources on a timely basis. Effect or potential effect The reporting and verification of the completeness and accuracy of the expenditures required more time than expected since this was the initial preparation of the Schedule and the unique requirements of the Covid-19 funds. Questioned costs None Identification of a repeat finding This is not a repeat finding. Context The audit was not completed and the reporting submitted within the earlier of 30 calendar days after receipt of the auditor’s report(s), or nine months after the end of the audit period as required by the Uniform Guidance. Recommendation The System’s should develop a formal process to prepare and review the Schedule and identify resources with appropriate knowledge to be involved in this process. View of responsible officials There is no disagreement with the audit finding.

Federal Program Information Federal Agency: U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) Award: Assistance Listing Number 93.461 COVID-19 - HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Award Period: February 4, 2020 - Ongoing Description: Internal control deficiency over review of claims prior to submission Type of Finding: Material Weakness in Internal Control Over Compliance Criteria or specific requirement (including statutory, regulatory or other citation) In accordance with Title 2 U.S. Code of Federal Regulations, Part 200.303, Internal controls, “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). A. Activities Allowed or Unallowed – Activities allowed include required primary health services as described in the terms and conditions of the award for uninsured individuals, including reimbursement of payments for COVID-19 testing and testing-related items for individuals who do not have coverage through an individual or employer-sponsored plan, a federal healthcare program, or the Federal Employees Health Benefits Program at the time the services were rendered. E. Eligibility – Services must be for individuals who at the time the services were provided were uninsured as described in the terms and conditions of the award. Condition The System did not retain audit evidence of its internal controls over its review and approval of claims ensuring the patients were eligible and the services are allowable under the program’s terms and conditions prior to submission on the HRSA portal for reimbursement. Cause Management designed a process to verify that claims were in full compliance with the program’s terms and conditions, noting patients were eligible and services were allowable, prior to submission to HRSA; however, they did not retain supporting documentation to evidence that the internal review controls were appropriately designed and functioning throughout the process. Effect or potential effect The patient could have had insurance coverage at the time the service was performed or the amount submitted for reimbursement could have been partially or wholly unallowable under the program’s terms and conditions, resulting in receiving funds from the HRSA COVID-19 Uninsured Program inappropriately or not providing refunds to HRSA on a timely basis. Questioned costs None Identification of a repeat finding This is not a repeat finding. Context Management did not retain evidence supporting their internal control over the process to seek reimbursement for claims submitted to the HRSA portal. Recommendation We recommend that management develop appropriate documentation to support the internal controls that would ensure claims are reviewed and complied with the program’s terms and conditions prior to submission on the HRSA portal to ensure appropriate reimbursement or that amounts required to be refunded to HRSA are analyzed on a timely basis View of responsible officials There is no disagreement with the audit finding.

Federal Program Information Federal Agency: U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) Award: Assistance Listing Number 93.461 COVID-19 - HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Award Period: February 4, 2020 - Ongoing Description: Timely Preparation of Schedule of Expenditures of Federal Awards Type of Finding: Material Weakness in Internal Control Over Compliance Criteria or specific requirement (including statutory, regulatory or other citation) In accordance with Title 2 U.S. Code of Federal Regulations, Part 200.303, Internal controls, “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 System had not developed a formal process to prepare and review its Schedule of Expenditures of Federal Awards and was not able to complete the Schedule for the year ended June 30, 2020 in a timely manner. Cause During the year ended June 30, 2020, the System was required to prepare the Schedule for the first time since its expenditures exceeded $750,000. This was primarily due to a new grant that arose suddenly in response to treating Covid-19 patients. Consequently, the System had not identified individuals with the appropriate knowledge and training to prepare the Schedule for this fiscal period. This also occurred as a result of Covid-19 which impacted the availability of resources due to the challenges presented to the System which were unexpected and strained existing resources and the ability to hire new resources on a timely basis. Effect or potential effect The reporting and verification of the completeness and accuracy of the expenditures required more time than expected since this was the initial preparation of the Schedule and the unique requirements of the Covid-19 funds. Questioned costs None Identification of a repeat finding This is not a repeat finding. Context The audit was not completed and the reporting submitted within the earlier of 30 calendar days after receipt of the auditor’s report(s), or nine months after the end of the audit period as required by the Uniform Guidance. Recommendation The System’s should develop a formal process to prepare and review the Schedule and identify resources with appropriate knowledge to be involved in this process. View of responsible officials There is no disagreement with the audit finding.

Federal Program Information Federal Agency: U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) Award: Assistance Listing Number 93.461 COVID-19 - HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Award Period: February 4, 2020 - Ongoing Description: Internal control deficiency over review of claims prior to submission Type of Finding: Material Weakness in Internal Control Over Compliance Criteria or specific requirement (including statutory, regulatory or other citation) In accordance with Title 2 U.S. Code of Federal Regulations, Part 200.303, Internal controls, “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). A. Activities Allowed or Unallowed – Activities allowed include required primary health services as described in the terms and conditions of the award for uninsured individuals, including reimbursement of payments for COVID-19 testing and testing-related items for individuals who do not have coverage through an individual or employer-sponsored plan, a federal healthcare program, or the Federal Employees Health Benefits Program at the time the services were rendered. E. Eligibility – Services must be for individuals who at the time the services were provided were uninsured as described in the terms and conditions of the award. Condition The System did not retain audit evidence of its internal controls over its review and approval of claims ensuring the patients were eligible and the services are allowable under the program’s terms and conditions prior to submission on the HRSA portal for reimbursement. Cause Management designed a process to verify that claims were in full compliance with the program’s terms and conditions, noting patients were eligible and services were allowable, prior to submission to HRSA; however, they did not retain supporting documentation to evidence that the internal review controls were appropriately designed and functioning throughout the process. Effect or potential effect The patient could have had insurance coverage at the time the service was performed or the amount submitted for reimbursement could have been partially or wholly unallowable under the program’s terms and conditions, resulting in receiving funds from the HRSA COVID-19 Uninsured Program inappropriately or not providing refunds to HRSA on a timely basis. Questioned costs None Identification of a repeat finding This is not a repeat finding. Context Management did not retain evidence supporting their internal control over the process to seek reimbursement for claims submitted to the HRSA portal. Recommendation We recommend that management develop appropriate documentation to support the internal controls that would ensure claims are reviewed and complied with the program’s terms and conditions prior to submission on the HRSA portal to ensure appropriate reimbursement or that amounts required to be refunded to HRSA are analyzed on a timely basis View of responsible officials There is no disagreement with the audit finding.