FAC Explorer

Finding 1167998 (2023-001)

Material Weakness Repeat Finding
Requirement
ABL
Questioned Costs
-
Year
2023
Accepted
2026-01-07
Audit: 379692
Organization: Marshfield Clinic Health System, Inc. (WI)
Auditor: FORVIS MAZARS LLP

AI Summary

  • Core Issue: Internal controls over reporting expenditures are inadequate, leading to approximately $49,000 in ineligible costs being submitted.
  • Impacted Requirements: Noncompliance with 2 CFR 200.303, which mandates effective internal controls for managing federal awards.
  • Recommended Follow-Up: Implement formal supervisory review and approval processes for expenditure reporting, ensuring documentation meets established criteria.

Finding Text

Finding 2023-001 – Allowable Costs and Reporting U.S. Department of Health and Human Services COVID-19 – Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing # 93.498 Significant Deficiency and Allowable Costs Noncompliance Criteria – 2 CFR 200.303 requires that a 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 and the “Internal Control Integrated Framework,” issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Condition – During our testing of compliance and internal controls over allowability of costs and reporting of expenditures, it was determined that internal controls over reporting are not designed to prevent and detect errors in expenditures being reported on the Department of Health Resources and Services Administration (HRSA) portal (Portal). Consequently, we noted approximately $49,000 of ineligible expenditures related to employee testing were submitted on the Portal for period 5. Cause – Lack of effectively designed and implemented internal controls over allowability of expenditures and reporting of expenditures in the Portal for period 5. Effect – Without the proper implementation of an effectively designed system of internal controls, the internal control system cannot be relied upon to effectively prevent or detect noncompliance. Questioned costs – $49,000. Context – Our testing noted approximately $49,000 of ineligible expenditures for employee testing out of a total of approximately $167,000 in expenditures that were reported on the Portal for period 5. Our sample was not intended to be statistically valid. Repeat Finding from Prior Year – Yes. See item 2022-004. Recommendation – Effective supervisory review and approval internal controls over reporting should be implemented to ensure expenditures submitted in the Portal meet the criteria established in the terms and conditions. Furthermore, the review and approval should be formally documented.

Corrective Action Plan

Finding 2023-001 Name of Contact Person: Debra Hansen, Accounting Manager – Grants and Gifts Corrective Action Plan: In December 2022, changes were made to the MCHS lab ordering process and a new report was created to track employee COVID test results. This report reflected two rows of information for each individual employee tested. One for the test order and a second for the test result. Each row was counted and costed as two separate employee tests and therefore a portion of the cost for employee COVID tests was accidentally doubled and overstated in the portal for Period 5. However, although these expenses were overstated by $49,000, the grant was not overcharged as these questioned costs would be fully replaceable by an allowable amount of unused eligible lost revenues of approximately $109,516,000. Management will implement a procedure that requires a second level review of expenditures reported to ensure accuracy of reimbursement claimed for federal- and state-funded expenditures.Completion Date: September 30, 2024

Categories

Allowable Costs / Cost Principles Eligibility Reporting Significant Deficiency Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

Other Findings in this Audit

  • 1167999 2023-002
    Material Weakness Repeat
  • 1168000 2023-002
    Material Weakness Repeat
  • 1168001 2023-002
    Material Weakness Repeat
  • 1168002 2023-002
    Material Weakness Repeat
  • 1168003 2023-002
    Material Weakness Repeat
  • 1168004 2023-002
    Material Weakness Repeat
  • 1168005 2023-002
    Material Weakness Repeat
  • 1168006 2023-002
    Material Weakness Repeat
  • 1168007 2023-002
    Material Weakness Repeat
  • 1168008 2023-002
    Material Weakness Repeat
  • 1168009 2023-002
    Material Weakness Repeat
  • 1168010 2023-002
    Material Weakness Repeat
  • 1168011 2023-002
    Material Weakness Repeat
  • 1168012 2023-002
    Material Weakness Repeat
  • 1168013 2023-002
    Material Weakness Repeat
  • 1168014 2023-002
    Material Weakness Repeat
  • 1168015 2023-002
    Material Weakness Repeat
  • 1168016 2023-002
    Material Weakness Repeat
  • 1168017 2023-002
    Material Weakness Repeat
  • 1168018 2023-002
    Material Weakness Repeat
  • 1168019 2023-002
    Material Weakness Repeat
  • 1168020 2023-002
    Material Weakness Repeat
  • 1168021 2023-002
    Material Weakness Repeat
  • 1168022 2023-002
    Material Weakness Repeat
  • 1168023 2023-002
    Material Weakness Repeat
  • 1168024 2023-002
    Material Weakness Repeat
  • 1168025 2023-002
    Material Weakness Repeat
  • 1168026 2023-002
    Material Weakness Repeat
  • 1168027 2023-002
    Material Weakness Repeat
  • 1168028 2023-002
    Material Weakness Repeat
  • 1168029 2023-002
    Material Weakness Repeat
  • 1168030 2023-002
    Material Weakness Repeat
  • 1168031 2023-002
    Material Weakness Repeat
  • 1168032 2023-002
    Material Weakness Repeat
  • 1168033 2023-002
    Material Weakness Repeat
  • 1168034 2023-002
    Material Weakness Repeat
  • 1168035 2023-002
    Material Weakness Repeat
  • 1168036 2023-002
    Material Weakness Repeat
  • 1168037 2023-002
    Material Weakness Repeat
  • 1168038 2023-002
    Material Weakness Repeat
  • 1168039 2023-002
    Material Weakness Repeat
  • 1168040 2023-002
    Material Weakness Repeat
  • 1168041 2023-002
    Material Weakness Repeat
  • 1168042 2023-002
    Material Weakness Repeat
  • 1168043 2023-002
    Material Weakness Repeat
  • 1168044 2023-002
    Material Weakness Repeat
  • 1168045 2023-002
    Material Weakness Repeat
  • 1168046 2023-003
    Material Weakness Repeat
  • 1168047 2023-003
    Material Weakness Repeat
  • 1168048 2023-003
    Material Weakness Repeat
  • 1168049 2023-003
    Material Weakness Repeat
  • 1168050 2023-003
    Material Weakness Repeat
  • 1168051 2023-003
    Material Weakness Repeat
  • 1168052 2023-003
    Material Weakness Repeat
  • 1168053 2023-003
    Material Weakness Repeat
  • 1168054 2023-003
    Material Weakness Repeat
  • 1168055 2023-003
    Material Weakness Repeat
  • 1168056 2023-003
    Material Weakness Repeat
  • 1168057 2023-003
    Material Weakness Repeat
  • 1168058 2023-003
    Material Weakness Repeat
  • 1168059 2023-003
    Material Weakness Repeat
  • 1168060 2023-003
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
10.766 COMMUNITY FACILITIES LOANS AND GRANTS $16.29M
93.310 TRANS-NIH RESEARCH SUPPORT $11.79M
93.498 PROVIDER RELIEF FUND $4.01M
93.399 CANCER CONTROL $2.67M
93.RD COVID-19 Community Cohort $2.55M
93.350 NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES $1.11M
93.RD CONNECT FOR CANCER PREVENTION STUDY $972,523
94.006 AMERICORPS $807,289
93.RD VACCINE SAFETY DATALINK INFRASTRUCTURE $445,855
93.859 BIOMEDICAL RESEARCH AND RESEARCH TRAINING $420,352
93.788 OPIOID STR $402,550
93.RD COVID-19 VACCINES IN THE VACCINE SAFTETY DATALINK $366,174
16.575 CRIME VICTIM ASSISTANCE $362,684
32.006 COVID-19 TELEHEALTH PROGRAM $345,061
93.959 BLOCK GRANTS FOR PREVENTION AND TREATMENT OF SUBSTANCE ABUSE $219,744
93.155 RURAL HEALTH RESEARCH CENTERS $195,677
93.323 EPIDEMIOLOGY AND LABORATORY CAPACITY FOR INFECTIOUS DISEASES (ELC) $151,956
93.RD RVTN - SENTINEL RESPIRATORY VIRUS TRANSMISSION NETWORK $151,691
93.866 AGING RESEARCH $138,570
93.393 CANCER CAUSE AND PREVENTION RESEARCH $92,847
21.027 CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY FUNDS $87,410
93.RD FLU VACCINE TRIAL $87,286
10.001 AGRICULTURAL RESEARCH_BASIC AND APPLIED RESEARCH $66,822
93.396 CANCER BIOLOGY RESEARCH $59,748
10.525 FARM AND RANCH STRESS ASSISTANCE NETWORK COMPETITIVE GRANTS PROGRAM (B) $57,319
93.395 CANCER TREATMENT RESEARCH $52,312
93.RD SENTINEL $50,705
93.RD CARDIOVASCULAR DISEASES RESEARCH $49,688
93.243 SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES_PROJECTS OF REGIONAL AND NATIONAL SIGNIFICANCE $48,822
93.RD VACCINE SAFETY DATALINK PROJECT, VSD COVID-19 INFRASTRUCTURE PARTICIPANTING SITE MONITORING FOR VACCINE-ASSOCIATED ENHANCED DISEASES $33,654
93.241 STATE RURAL HOSPITAL FLEXIBILITY PROGRAM $28,724
93.898 CANCER PREVENTION AND CONTROL PROGRAMS FOR STATE, TERRITORIAL AND TRIBAL ORGANIZATIONS $28,346
93.912 RURAL HEALTH CARE SERVICES OUTREACH, RURAL HEALTH NETWORK DEVELOPMENT AND SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT $28,243
93.426 IMPROVING THE HEALTH OF AMERICANS THROUGH PREVENTION AND MANAGEMENT OF DIABETES AND HEART DISEASE AND STROKE $27,044
93.073 BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES - PREVENTION AND SURVEILLANCE $26,401
93.262 OCCUPATIONAL SAFETY AND HEALTH PROGRAM $26,232
93.RD Optimal Strategies to Estimate the Relative Effectiveness of Influenza $25,003
10.212 SMALL BUSINESS INNOVATION RESEARCH $21,373
93.643 CHILDREN'S JUSTICE GRANTS TO STATES $10,016
93.435 INNOVATIVE STATE AND LOCAL PUBLIC HEALTH STRATEGIES TO PREVENT AND MANAGE DIABETES AND HEART DISEASE AND STROKE- $10,000
93.988 COOPERATIVE AGREEMENTS FOR STATE-BASED DIABETES CONTROL PROGRAMS AND EVALUATION OF SURVEILLANCE SYSTEMS $9,747
93.421 STRENGTHENING PUBLIC HEALTH SYSTEMS AND SERVICES THROUGH NATIONAL PARTNERSHIPS TO IMPROVE AND PROTECT THE NATION’S HEALTH $9,468
93.307 MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH $6,451
93.301 SMALL RURAL HOSPITAL IMPROVEMENT GRANT PROGRAM $5,950
93.153 COORDINATED SERVICES AND ACCESS TO RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND YOUTH $5,282
93.837 CARDIOVASCULAR DISEASES RESEARCH $4,465
10.303 INTEGRATED PROGRAMS $4,416
93.279 DRUG ABUSE AND ADDICTION RESEARCH PROGRAMS $4,325
93.394 CANCER DETECTION AND DIAGNOSIS RESEARCH $2,633
93.575 CHILD CARE AND DEVELOPMENT BLOCK GRANT $1,326
93.855 ALLERGY, IMMUNOLOGY AND TRANSPLANTATION RESEARCH $1,283
93.RD ALLERGY AND INFECTIOUS DISEASES RESEARCH $945
93.211 TELEHEALTH PROGRAMS $922
93.RD VACCINE SAFETY DATALINK SHINGRIX PARTICIPATING SITE $351
93.865 CHILD HEALTH AND HUMAN DEVELOPMENT EXTRAMURAL RESEARCH $25
93.185 IMMUNIZATION RESEARCH, DEMONSTRATION, PUBLIC INFORMATION AND EDUCATION_TRAINING AND CLINICAL SKILLS IMPROVEMENT PROJECTS $-956
93.RD EVALUATING INFLUENZA AND SARSCO V-2 VACCINE EFFECTIVENESS $-5,376