Finding 1159410 (2024-001)

Material Weakness Repeat Finding
Requirement
L
Questioned Costs
-
Year
2024
Accepted
2025-09-30
Audit: 370132
Auditor: Grady

AI Summary

  • Core Issue: A payroll disbursement of $1,988 was reimbursed despite being unallowable under grant terms.
  • Impacted Requirements: Internal controls were insufficient to prevent unallowable costs from being submitted for federal reimbursement.
  • Recommended Follow-Up: Strengthen management review processes and retrain staff on submission and approval procedures to avoid future issues.

Finding Text

Finding No: 2024-001 Activities Allowed or Unallowed/Allowable Costs Federal Agency: U.S. Department of Health and Human Services Assistance Listing Number: 93.778 Program: Medicaid Assistance Program/Medicaid Cluster Award Years: January 1, 2024 – December 31, 2024 (a) Criteria or Requirement Per 2 CFR 200.303, a non-Federal entity 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. Additionally, the specific requirements for activities allowed or unallowed are unique to each federal program and are found in the federal statutes, regulations, and the terms and conditions of the federal award pertaining to the program. (b) Condition Found, Including Perspective For one of 40 payroll disbursements tested during the fiscal year 2024 reporting period there was one disbursement totaling $1,988 in which expenditure was approved, requested for reimbursement, and reimbursed by the federal agency, however, per the terms of the grant agreement this disbursement was not allowable. This disbursement was specifically related to a payroll code that was not frequently used by the System and a code typically removed from the reimbursement request before being submitted. (c) Possible Cause While the System performs a review of documentation before payments are requested for reimbursement, controls were not designed or implemented effectively to ensure that unallowable payroll charges were not submitted for reimbursement by the federal agency. (d) Questioned Cost No questioned costs as amounts did not exceed the threshold for reporting. (e) Effect Federal funds were expended for unallowable amounts and evidence of the effective operation of management review controls was not consistently maintained in accordance with Federal requirements. (f) Statistical Validity The sample was not intended to be, and was not, a statistically valid sample. (g) Repeat Finding in the Prior Year This finding is not a repeat finding. (h) Recommendation We recommend that the System strengthen controls over the management review process to prevent unallowable costs from being charged to Federal programs. (i) View of Responsible Officials Management concurs with the finding. While appropriate controls exist relative to management review of expenditures, opportunities exist to retrain staff and further enhance controls related to procedures for submission, review, and approval of expenditures before submission for reimbursement.

Corrective Action Plan

To: FY2024 Uniform Guidance Reporting Package From: David Noble, Director, Grant Administration RE: 2024 Uniform Guidance Audit Corrective Action Plan Date: September 25, 2025 Finding: 2024-001 Activities Allowed or Unallowed/Allowable Costs Federal Program: Medicaid Assistance Program/Medicaid Cluster ALN: 93.778 Grady Memorial Hospital Corporation’s 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 update our controls and processes to include additional review of expenses incurred during the relevant audit period. Grady’s corrective action plan: During the FY 2024 single audit, one unallowable payroll disbursement totaling $1,988 was reimbursed by the federal agency. The disbursement was associated with a rarely used payroll code that is routinely excluded from reimbursement requests. Internal controls over the review process for payroll charges exist and will be strengthened to ensure only allowable charges are charged to the grant. Contact person/s responsible for the corrective action: David Noble, Director, Grant Administration Anticipated Completion Date: Consistent with 2025 Financial Audit Reporting

Categories

Allowable Costs / Cost Principles Cash Management Reporting Matching / Level of Effort / Earmarking

Other Findings in this Audit

  • 1159407 2024-001
    Material Weakness Repeat
  • 1159408 2024-001
    Material Weakness Repeat
  • 1159409 2024-001
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.914 Hiv Emergency Relief Project Grants $9.74M
93.686 Ending the Hiv Epidemic: A Plan for America — Ryan White Hiv/aids Program Parts A and B $1.53M
16.753 Congressionally Recommended Awards $969,353
93.153 Coordinated Services and Access to Research for Women, Infants, Children, and Youth $947,364
93.253 Poison Center Support and Enhancement Grant $764,386
21.027 Coronavirus State and Local Fiscal Recovery Funds $738,795
93.778 Medical Assistance Program $690,080
16.045 Community-Based Violence Intervention and Prevention Initiative $526,001
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $438,652
16.575 Crime Victim Assistance $435,467
93.217 Family Planning Services $396,872
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $394,833
93.788 Opioid Str $381,607
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $330,721
93.051 Alzheimer's Disease Demonstration Grants to States $275,934
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $229,512
93.069 Public Health Emergency Preparedness $192,338
93.958 Block Grants for Community Mental Health Services $188,803
93.924 Ryan White Hiv/aids Dental Reimbursement and Community Based Dental Partnership Grants $187,868
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance $178,476
93.078 Strengthening Emergency Care Delivery in the United States Healthcare System Through Health Information and Promotion $154,838
93.150 Projects for Assistance in Transition From Homelessness (path) $153,815
93.959 Block Grants for Prevention and Treatment of Substance Abuse $143,279
93.226 Research on Healthcare Costs, Quality and Outcomes $130,539
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $121,585
84.063 Federal Pell Grant Program $119,777
93.145 Hiv-Related Training and Technical Assistance $100,860
93.310 Trans-Nih Research Support $79,561
16.588 Violence Against Women Formula Grants $77,878
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $77,576
93.121 Oral Diseases and Disorders Research $50,986
16.017 Sexual Assault Services Formula Program $47,065
93.497 Family Violence Prevention and Services/ Sexual Assault/rape Crisis Services and Supports $30,545
93.397 Cancer Centers Support Grants $23,070
93.421 Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nation’s Health $8,268