Finding 1072813 (2023-001)

Significant Deficiency
Requirement
L
Questioned Costs
$1
Year
2023
Accepted
2024-09-10
Audit: 319252
Organization: Banner Health (AZ)

AI Summary

  • Core Issue: Internal control deficiencies led to an overstatement of lost revenues in the provider relief fund report due to duplication.
  • Impacted Requirements: Compliance with federal regulations requires effective internal controls to prevent duplication of reported lost revenues.
  • Recommended Follow-Up: Management should implement stronger internal controls to ensure accurate reporting of lost revenues and review questioned costs for potential improper payments.

Finding Text

Internal control deficiency and noncompliance over reporting of lost revenues attributable to coronavirus reported in the provider relief fund report. Identification of the federal program: Assistance Listing Number 93.498: • COVID-19 – Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution • U.S. Department of Health and Human Services • Federal award identification number – Not Applicable • Federal award year – January 1, 2020 to December 31, 2023 Criteria or specific requirement (including statutory, regulatory or other citation): Title 2, Subtitle A, Chapter II, Part 200, Subpart D, Section 200.303 Internal controls. The non-Federal entity must: (a) 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). The terms and conditions of the award requires the following: • The recipient certifies that the payment will only be used to prevent, prepare for, and respond to coronavirus, and that the payment shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. • The recipient certifies that it will not use the payment to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. • The recipient shall adhere to the reporting requirements on provider relief fund payments for payments received exceeding $10,000 in the aggregate during the payment received period. The recipient must register in the provider relief fund reporting portal and submit reports as specified by HHS. • The recipient certifies that all information it provides as part of any application for the payment, as well as all information and reports relating to the payment that it provides in the future at the request of HHS or the HHS inspector general, are true, accurate and complete, to the best of its knowledge. The Provider Relief Programs: Provider Relief Fund and ARP Rural Payments Frequently Asked Questions states the following: • Duplication of expenses and lost revenues is not permitted. • Expenses and lost revenues may not be duplicated: payments may not be applied to the same expenses and lost revenues that were reported on in prior reporting period. Condition: During our testing over reporting, we observed management did not have effective internal controls in place to ensure lost revenues reported in the provider relief fund report were not duplicated. This resulted in an overstatement of lost revenues reported in the provider relief fund report. Cause: Management did not have effective internal controls in place over the compliance requirements as stated in the criteria or specific requirements section above. Effect or potential effect: The lost revenues attributable to coronavirus were reported incorrectly in the provider relief fund report. Questioned costs: $404,529 – Assistance Listing Number 93.498, Award Identification Number – Not Applicable Questioned costs were computed by taking the total lost revenues available to be used in the current reporting period of $29,770,743 reported in the provider relief fund report compared to the actual total lost revenues available to be used in the current reporting period of $29,366,214. Context: During our testing over the calculation of lost revenues attributable to coronavirus, we observed management used $404,529 in lost revenues related to a subsidiary of Banner to substantiate the payments received; however, the Banner parent lost revenues were not reduced by $404,529 in lost revenues that were already used by the subsidiary of Banner. Management’s control regarding the review of the provider relief fund report did not identify this overstatement. Identification as a repeat finding, if applicable: No. Recommendation: Management should develop and implement effective internal controls to ensure the total lost revenues reported in the provider relief fund report are reflective of the entity’s consolidated lost revenues and are not duplicated. In addition, management should review the identified questioned costs to identify if any improper payments were made to the entity. Views of responsible officials: There will be no additional provider relief fund reports submitted given this was the final report submitted to substantiate the payments received. However, if this program begins again, management will implement a control to ensure lost revenues are not duplicated. The entity will work with the grantor regarding the questioned costs identified.

Categories

Questioned Costs Internal Control / Segregation of Duties Reporting Matching / Level of Effort / Earmarking

Other Findings in this Audit

  • 496371 2023-001
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.498 Covid-19 - Provider Relief Fund and American Rescue Plan (arp) Rural Distribution $59.19M
97.036 Covid-19 - Disaster Grants - Public Assistance (presidentially Declared Disasters) $10.81M
93.310 Trans-Nih Research Support $1.16M
93.253 Poison Control Stabilization and Enhancement Grants $289,025
93.307 Minority Health and Health Disparities Research $135,047
21.027 Covid-19 - Coronavirus State and Local Fiscal Recovery Funds $132,000
93.155 Covid-19 - Rural Health Research Centers $119,195
93.838 Covid-19 - Lung Diseases Research $93,875
93.866 Aging Research $67,360
93.855 Allergy and Infectious Diseases Research $56,421
93.395 Cancer Treatment Research $50,500
93.137 Covid-19 - Community Programs to Improve Minority Health Grant Program $43,412
93.470 Alzheimer's Disease Program Initiative (adpi) $42,500
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $33,070
93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders $21,373
93.393 Cancer Cause and Prevention Research $17,887
93.048 Covid-19 - Special Programs for the Aging, Title Iv, and Title Ii, Discretionary Projects $10,537
93.301 Small Rural Hospital Improvement Grant Program $9,559
93.426 The National Cardiovascular Health Program $7,900
93.286 Discovery and Applied Research for Technological Innovations to Improve Human Health $5,258
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $1,269
93.575 Covid-19 - Child Care and Development Block Grant $680