FAC Explorer

Finding 1158234 (2023-001)

Material Weakness Repeat Finding
Requirement
L
Questioned Costs
-
Year
2023
Accepted
2025-09-30
Audit: 370125
Organization: Grady Memorial Hospital Corporation (GA)
Auditor: Kpmg

AI Summary

  • Core Issue: Insufficient documentation of management's review for the HRSA portal submission prior to submission to the U.S. Department of Health and Human Services.
  • Impacted Requirements: Compliance with 45 CFR section 75.303, which mandates effective internal controls and proper documentation for federal awards.
  • Recommended Follow-Up: Ensure management implements and maintains controls to document grant report reviews before submission.

Finding Text

Finding 2023-001 – Reporting Federal Program: Provider Relief Fund and American Rescue Plan Rural Distribution ALN: 93.498 Federal Agency: U.S. Department of Health and Human Services Federal Award Years: July 1, 2023 to September 30, 2023 and January 1, 2024 to March 31, 2024. Criteria: 45 CFR section 75.303 (a) states non-federal entities must: 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). 45 CFR section 75.303 (b) states non-federal entities must: Comply with Federal statutes, regulations, and the terms and conditions of the Federal awards. Recipients of provider relief funds must support all expenses with adequate documentation and maintain proper control documentation to substantiate that these funds were used for health care-related expenses or lost revenues attributable to coronavirus. Condition Found, Including Perspective: There is not sufficient documentation to evidence management’s review of the HRSA portal submission prior to submission to the U.S. Department of Health and Human Services. Possible Cause and Effect: While Grady Memorial Hospital Corporation maintains that appropriate management review did take place prior to the portal submission, controls were not designed or implemented effectively to maintain evidence of management’s review. Formal documentation of the review occurred subsequent to the HRSA portal submission. Questioned Costs: None. Statistical Validity: The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding in the Prior Year: Yes: Finding 2022-002 – Reporting Recommendation We recommend that management implement appropriate controls and processes to review the grant reports prior to submission and to provide evidence of the related review. Views of Responsible Officials: Grady Memorial Hospital Corporation has implemented controls and processes to ensure grant reports are reviewed prior to submission and that evidence of review is maintained.

Corrective Action Plan

To: FY2023 Uniform Guidance Reporting Package From: Gina Smith, VP, Fiscal Service/Controller RE: 2023 Uniform Guidance Audit Corrective Action Plan Date: 9/27/2024 Finding 2023-001 – Reporting Federal Program: Provider Relief Fund and American Rescue Plan Rural Distribution ALN: 93.498 Grady Memorial Hospital Corporation’s (Grady) CFO and VP of Fiscal Services/Controller have reviewed the reporting from KPMG relating to the Uniform Guidance. We understand the recommendation set forth by KPMG and will revamp our controls and processes to include additional management review of the SEFA to include the prior of any submission and to provide evidence of the related review Grady’s corrective action plan: Grady Memorial Hospital Corporation has implemented a new review policy for the submissions of PRF reports which also includes a new reporting and review procedure that are performed by the Controller and Tax & Technical Accounting Manager. GMHC will implement controls and processes to ensure grant reports are reviewed prior to submission and that evidence of review is maintained within the timeline it was signed. Contact person/s responsible for the correction action: Gina Smith, VP, Fiscal Service/Controller Anticipated Completion Date: Grady Memorial Hospital Corporation has implemented controls and processes to ensure grant reports are reviewed prior to submission and that evidence of review is maintained

Categories

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

Other Findings in this Audit

  • 1158235 2023-002
    Material Weakness Repeat
  • 1158236 2023-002
    Material Weakness Repeat
  • 1158237 2023-002
    Material Weakness Repeat
  • 1158238 2023-002
    Material Weakness Repeat
  • 1158239 2023-002
    Material Weakness Repeat
  • 1158240 2023-003
    Material Weakness Repeat
  • 1158241 2023-003
    Material Weakness Repeat
  • 1158242 2023-003
    Material Weakness Repeat
  • 1158243 2023-003
    Material Weakness Repeat
  • 1158244 2023-003
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.498 Provider Relief Fund and American Rescue Plan (arp) Rural Distribution $12.45M
93.914 Hiv Emergency Relief Project Grants $9.56M
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $8.77M
21.027 Coronavirus State and Local Fiscal Recovery Funds $3.93M
93.153 Coordinated Services and Access to Research for Women, Infants, Children, and Youth $837,549
16.575 Crime Victim Assistance $774,269
93.778 Medical Assistance Program $680,504
93.253 Poison Center Support and Enhancement Grant $677,758
16.753 Congressionally Recommended Awards $532,366
93.686 Ending the Hiv Epidemic: A Plan for America — Ryan White Hiv/aids Program Parts A and B $461,877
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $434,633
93.217 Family Planning Services $387,500
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $369,140
93.145 Hiv-Related Training and Technical Assistance $356,297
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $326,398
93.051 Alzheimer's Disease Demonstration Grants to States $325,759
93.788 Opioid Str $295,016
93.958 Block Grants for Community Mental Health Services $203,968
93.069 Public Health Emergency Preparedness $184,500
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $175,022
93.310 Trans-Nih Research Support $131,046
93.150 Projects for Assistance in Transition From Homelessness (path) $106,184
93.078 Strengthening Emergency Care Delivery in the United States Healthcare System Through Health Information and Promotion $92,925
84.063 Federal Pell Grant Program $80,527
93.421 Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nation’s Health $78,642
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $77,576
93.924 Ryan White Hiv/aids Dental Reimbursement and Community Based Dental Partnership Grants $70,211
93.497 Family Violence Prevention and Services/ Sexual Assault/rape Crisis Services and Supports $45,292
93.397 Cancer Centers Support Grants $25,025
93.136 Injury Prevention and Control Research and State and Community Based Programs $18,023
93.121 Oral Diseases and Disorders Research $17,668
93.959 Block Grants for Prevention and Treatment of Substance Abuse $6,970
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance $3,464