Audit 8554

Finding 2021-005 Program Name/CFDA Title: Provider Relief Fund Federal Assistance Listing Number: 93.498 Federal Agency: U.S. Department of Health and Human Services Type of Finding: Significant Deficiency Compliance Requirement: Reporting Condition: The Organization’s internal controls over compliance related to reporting were not effective. Criteria: The Provider Relief Funds (PRF) were provided under the Coronavirus Aid, Relief, and Economic Security Act (Pub. L. No. 116-136, 134 Stat. 563). Recipients agreed to terms and conditions, which require compliance with reporting requirements as specified by the Secretary of the U.S. Department of Health and Human Services (HHS). Context: The audit was not completed and submitted to the Health Resources and Services Administration’s Division of Financial Integrity by the September 30, 2022 deadline. Cause: Internal controls over audit report submission were not operating effectively. Questioned Costs: None. Effect: The Organization did not submit the audit report to the Health Resources and Services Administration’s Division of Financial Integrity by the due date of September 30, 2022. Recommendation: We recommend the Organization put processes in place over reporting to ensure timely submission of the audit report. Response of Responsible Officials: The Organization concurs with this recommendation. Management will put processes into place to ensure timely submission of the audit report prior to the reporting deadline.

Finding 2021-006 Program Name/CFDA Title: Provider Relief Fund Federal Assistance Listing Number: 93.498 Federal Agency: U.S. Department of Health and Human Services Type of Finding: Significant Deficiency Compliance Requirement: Reporting Condition: The Organization’s internal controls over compliance related to reporting were not effective. Criteria: The Provider Relief Funds (PRF) were provided under the Coronavirus Aid, Relief, and Economic Security Act (Pub. L. No. 116-136, 134 Stat. 563). Recipients agreed to terms and conditions, which require compliance with reporting requirements as specified by the Secretary of the U.S. Department of Health and Human Services (HHS). Context: During the audit, it was determined that the allocation of previously reported amounts of other PRF expenses and lost revenues within the Period 1 portal submission would need to be revised. However, it was noted that the revisions would not impact the total amount claimed for reimbursement, and therefore there was no impact on the amount recognized in the Schedule of Expenditures of Federal Awards in total. Cause: Internal controls over grant reporting were not operating effectively. Questioned Costs: None. Effect: The Organization’s internal controls over grant reporting were not adequate to ensure accurate Period 1 portal reporting under the grant. Recommendation: We recommend the Organization put processes in place to ensure accurate portal reporting under the grant. We also recommend monitoring future reporting within the portal to ensure the allocation of expenses attributable to coronavirus and lost revenues are accurately updated. Response of Responsible Officials: The Organization concurs with this recommendation. Management will implement a control over the preparation and review over the completion and submission of the special reports to the government website. The submission will be prepared and documented and will be reviewed by another experienced individual. Any comments will be documented and followed up by staff documenting and evidencing the review.

Finding 2021-007 Program Name/CFDA Title: Provider Relief Fund Federal Assistance Listing Number: 93.498 Federal Agency: U.S. Department of Health and Human Services Type of Finding: Significant Deficiency Compliance Requirement: Allowable Costs, Cost Principles Condition: The Organization’s internal controls over compliance related to expenses were not effective. Criteria: The Provider Relief Funds (PRF) were provided under the Coronavirus Aid, Relief, and Economic Security Act (Pub. L. No. 116-136, 134 Stat. 563) and are to be used to prevent, prepare for, and respond to coronavirus. The funds are to be used to reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Context: During the audit, it was determined that 7 of 40 expenses tested did not have adequate supporting documentation and did not appear to be related to the prevention, preparation, or response to coronavirus, and 1 of 40 expenses tested included a coding error where an amount from the invoice was incorrectly recorded to coronavirus expense. Cause: Management oversight over coronavirus expenses was not effective. Questioned Costs: None. Effect: The Organization’s internal controls around compliance were not effective. Recommendation: We recommend that management review all expenditures for federal awards for accuracy under the criteria provided by the U.S. Department of Health and Human Services to ensure all supporting documentation is properly maintained and all errors are identified and corrected timely. Response of Responsible Officials: The Organization concurs with this recommendation. Management will review calculations and supporting documentation for all expenditures for federal awards to ensure accuracy in future reporting.

Finding 2021-005 Program Name/CFDA Title: Provider Relief Fund Federal Assistance Listing Number: 93.498 Federal Agency: U.S. Department of Health and Human Services Type of Finding: Significant Deficiency Compliance Requirement: Reporting Condition: The Organization’s internal controls over compliance related to reporting were not effective. Criteria: The Provider Relief Funds (PRF) were provided under the Coronavirus Aid, Relief, and Economic Security Act (Pub. L. No. 116-136, 134 Stat. 563). Recipients agreed to terms and conditions, which require compliance with reporting requirements as specified by the Secretary of the U.S. Department of Health and Human Services (HHS). Context: The audit was not completed and submitted to the Health Resources and Services Administration’s Division of Financial Integrity by the September 30, 2022 deadline. Cause: Internal controls over audit report submission were not operating effectively. Questioned Costs: None. Effect: The Organization did not submit the audit report to the Health Resources and Services Administration’s Division of Financial Integrity by the due date of September 30, 2022. Recommendation: We recommend the Organization put processes in place over reporting to ensure timely submission of the audit report. Response of Responsible Officials: The Organization concurs with this recommendation. Management will put processes into place to ensure timely submission of the audit report prior to the reporting deadline.

Finding 2021-006 Program Name/CFDA Title: Provider Relief Fund Federal Assistance Listing Number: 93.498 Federal Agency: U.S. Department of Health and Human Services Type of Finding: Significant Deficiency Compliance Requirement: Reporting Condition: The Organization’s internal controls over compliance related to reporting were not effective. Criteria: The Provider Relief Funds (PRF) were provided under the Coronavirus Aid, Relief, and Economic Security Act (Pub. L. No. 116-136, 134 Stat. 563). Recipients agreed to terms and conditions, which require compliance with reporting requirements as specified by the Secretary of the U.S. Department of Health and Human Services (HHS). Context: During the audit, it was determined that the allocation of previously reported amounts of other PRF expenses and lost revenues within the Period 1 portal submission would need to be revised. However, it was noted that the revisions would not impact the total amount claimed for reimbursement, and therefore there was no impact on the amount recognized in the Schedule of Expenditures of Federal Awards in total. Cause: Internal controls over grant reporting were not operating effectively. Questioned Costs: None. Effect: The Organization’s internal controls over grant reporting were not adequate to ensure accurate Period 1 portal reporting under the grant. Recommendation: We recommend the Organization put processes in place to ensure accurate portal reporting under the grant. We also recommend monitoring future reporting within the portal to ensure the allocation of expenses attributable to coronavirus and lost revenues are accurately updated. Response of Responsible Officials: The Organization concurs with this recommendation. Management will implement a control over the preparation and review over the completion and submission of the special reports to the government website. The submission will be prepared and documented and will be reviewed by another experienced individual. Any comments will be documented and followed up by staff documenting and evidencing the review.

Finding 2021-007 Program Name/CFDA Title: Provider Relief Fund Federal Assistance Listing Number: 93.498 Federal Agency: U.S. Department of Health and Human Services Type of Finding: Significant Deficiency Compliance Requirement: Allowable Costs, Cost Principles Condition: The Organization’s internal controls over compliance related to expenses were not effective. Criteria: The Provider Relief Funds (PRF) were provided under the Coronavirus Aid, Relief, and Economic Security Act (Pub. L. No. 116-136, 134 Stat. 563) and are to be used to prevent, prepare for, and respond to coronavirus. The funds are to be used to reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Context: During the audit, it was determined that 7 of 40 expenses tested did not have adequate supporting documentation and did not appear to be related to the prevention, preparation, or response to coronavirus, and 1 of 40 expenses tested included a coding error where an amount from the invoice was incorrectly recorded to coronavirus expense. Cause: Management oversight over coronavirus expenses was not effective. Questioned Costs: None. Effect: The Organization’s internal controls around compliance were not effective. Recommendation: We recommend that management review all expenditures for federal awards for accuracy under the criteria provided by the U.S. Department of Health and Human Services to ensure all supporting documentation is properly maintained and all errors are identified and corrected timely. Response of Responsible Officials: The Organization concurs with this recommendation. Management will review calculations and supporting documentation for all expenditures for federal awards to ensure accuracy in future reporting.