Finding 1170423 (2022-002)

Material Weakness Repeat Finding
Requirement
P
Questioned Costs
-
Year
2022
Accepted
2026-01-23
Audit: 383596
Organization: Baltimore Medical System, Inc. (MD)
Auditor: RSM US LLP

AI Summary

  • Core Issue: The auditee's Schedule of Expenditures of Federal Awards (SEFA) had discrepancies in identifying Assistance Listing Numbers and lacked supporting details for expenditures.
  • Impacted Requirements: The inaccuracies violate the Uniform Administrative Requirements, risking unreliable federal expenditure reporting to stakeholders.
  • Recommended Follow-Up: Implement a formal review process, ensure reconciliation of SEFA data with accounting records, and train staff on SEFA preparation requirements.

Finding Text

Federal Award Agency: U.S. Department of Health and Human Services Federal Awards: 93.224 / 93.527 – Health Center Program Cluster, 93.566 - Refugee and Entrant Assistance State/Replacement Designee Administered Programs, and 93.526 – Grants for Capital Development in Health Centers Criteria: The auditee must prepare a Schedule of Expenditures of Federal Awards (SEFA) that accurately presents total federal expenditures for each program, including information on pass-through awards and subrecipients. This is required by the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (2 CFR Part 200, §200.510(b)). Condition: During the audit of the auditee's SEFA for the year ended December 31, 2022, we noted discrepancies related to incorrect identification of Assistance Listing Numbers for certain grants, as well as difficulty providing initial supporting detail for balances of expenditures for certain Federal programs. Effect: The inaccurate SEFA presented an unreliable representation of the auditee's federal expenditures to external stakeholders, including the federal awarding agency and any pass-through entities. This condition could lead to: • Increased scrutiny from grantors. • Inaccurate information being submitted to the Federal Audit Clearinghouse. • The potential misallocation or mismanagement of federal funds. • An opinion modification on the SEFA from the independent auditor, particularly regarding its presentation in relation to the financial statements. Cause: The auditee lacks sufficient internal controls over the preparation and review of the SEFA. Specifically, there is no established process to reconcile federal expenditures reported on the SEFA to the auditee's underlying accounting records. A formal review process involving an individual independent of the preparation was not conducted to ensure the SEFA was complete and accurate before submission to the auditors. Recommendation: We recommend the auditee implement the following corrective actions: • Establish and document a formal, multi-level review process for the SEFA before it is submitted for audit. • Require that a staff member independent of the SEFA's preparation perform a detailed reconciliation of the SEFA's data to the general ledger and supporting grant documents. • Enhance internal controls to ensure all federal awards are properly identified, logged, and included on the SEFA, including all required details such as the ALN, pass-through entity, and subrecipient information. • Train relevant staff on the requirements for accurate SEFA preparation, including the required notes and the importance of using the correct ALN. Repeat finding?: No Views of responsible officials and planned corrective actions: See attached letter. Reportable questioned costs: None

Corrective Action Plan

Finding: During the audit of the auditee's SEFA for the year ended December 31, 2022, we noted discrepancies related to incorrect identification of Assistance Listing Numbers for certain grants, as well as difficulty providing initial supporting detail for balances of expenditures for certain Federal programs. The auditee lacks sufficient internal controls over the preparation and review of the SEFA. Specifically, there is no established process to reconcile federal expenditures reported on the SEFA to the auditee's underlying accounting records. A formal review process involving an individual independent of the preparation was not conducted to ensure the SEFA was complete and accurate before submission to the auditors. Views of responsible officials and planned corrective actions: Management agrees with the recommendation to establish and document a formal, multilevel review process for the preparation of the SEFA. Baltimore Medical System recently hired a new grant accountant who will be responsible for the preparation of the SEFA. • The Controller will perform a detailed reconciliation of the SEFA’s data to the general ledger and supporting grant documents. • The Grant Accountant will develop a central repository that includes all grant contracts/awards and a summary document which contains the grant name, grantee, award amount and period, Assistance Listing Numbers, pass-through entity and subrecipient information. • Train relevant staff on the SEFA requirements governed by the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for the Federal Awards (2 CFR Part 200, 200.510(b)). Anticipated date of completion: December 31, 2025 Contact person responsible – Tammy Grinnan, Controller and Margaret Boemmel, CFO

Categories

Subrecipient Monitoring Allowable Costs / Cost Principles Reporting

Other Findings in this Audit

  • 1170418 2022-002
    Material Weakness Repeat
  • 1170419 2022-002
    Material Weakness Repeat
  • 1170420 2022-002
    Material Weakness Repeat
  • 1170421 2022-002
    Material Weakness Repeat
  • 1170422 2022-002
    Material Weakness Repeat
  • 1170424 2022-003
    Material Weakness Repeat
  • 1170425 2022-003
    Material Weakness Repeat
  • 1170426 2022-003
    Material Weakness Repeat
  • 1170427 2022-003
    Material Weakness Repeat
  • 1170428 2022-003
    Material Weakness Repeat
  • 1170429 2022-003
    Material Weakness Repeat
  • 1170430 2022-004
    Material Weakness Repeat
  • 1170431 2022-004
    Material Weakness Repeat
  • 1170432 2022-004
    Material Weakness Repeat
  • 1170433 2022-004
    Material Weakness Repeat
  • 1170434 2022-005
    Material Weakness Repeat
  • 1170435 2022-005
    Material Weakness Repeat
  • 1170436 2022-005
    Material Weakness Repeat
  • 1170437 2022-005
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.224 CONSOLIDATED HEALTH CENTERS (COMMUNITY HEALTH CENTERS, MIGRANT HEALTH CENTERS, HEALTH CARE FOR THE HOMELESS, AND PUBLIC HOUSING PRIMARY CARE) $7.39M
93.527 AFFORDABLE CARE ACT (ACA) GRANTS FOR NEW AND EXPANDED SERVICES UNDER THE HEALTH CENTER PROGRAM $4.97M
93.526 AFFORDABLE CARE ACT (ACA) GRANTS FOR CAPITAL DEVELOPMENT IN HEALTH CENTERS $1.11M
93.566 REFUGEE AND ENTRANT ASSISTANCE_STATE ADMINISTERED PROGRAMS $994,389
93.217 FAMILY PLANNING_SERVICES $83,609
93.297 TEENAGE PREGNANCY PREVENTION PROGRAM $59,789
93.800 ORGANIZED APPROACHES TO INCREASE COLORECTAL CANCER SCREENING $54,161
93.224 AFFORDABLE CARE ACT (ACA) GRANTS FOR NEW AND EXPANDED SERVICES UNDER THE HEALTH CENTER PROGRAM $42,850
93.870 MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING GRANT $35,754
93.501 AFFORDABLE CARE ACT (ACA) GRANTS FOR SCHOOL-BASED HEALTH CENTER CAPITAL EXPENDITURES $2,488