Finding 1182621 (2025-001)

Finding 2025-001 – Activities Allowed or Unallowed and Allowable Costs/Cost Principles Identification of the federal program: Federal Grantor: United States Department of the Treasury Assistance Listing Number: 21.027, COVID-19 Coronavirus State and Local Fiscal Recovery Funds Pass-Through Entity: State of Tennessee Department of Health Ascension Ministry Market: Saint Thomas Medical Partners dba Ascension Medical Group (Ascension, Tennessee) Pass-Through Award Number: Not applicable Pass-Through Award Period: 11/1/2022 – 06/30/2026 Criteria or specific requirement (including statutory, regulatory or other citation): Section 200.303 of the Uniform Guidance states the following regarding internal control: “The recipient and subrecipient must establish, document, and maintain effective internal control over the Federal award that provides reasonable assurance that the recipient or subrecipient is managing the federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. The internal controls should align with the 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).” Condition: Time and Effort (T&E) certification reports related to certain employees’ salary charged during the year to the federal award were not reviewed timely. Cause: T&E certification reports were processed without timely Project Manager review and approval at Ascension Medical Group Effect or potential effect: Costs may be charged to the federal award that do not comply with federal or pass-through grant requirements. Questioned costs: None. Context: Of the 14 T&E certification reports sampled (totaling $144,738), six T&E certification reports (totaling $31,596) did not evidence timely review and approval by the employee's Project Manager for Ascension Medical Group. For Assistance Listing No. 21.027, total payroll costs for Ascension, Tennessee, were $525,874, representing 3.3% of total federal expenditures of $15,919,235 for the year ended June 30, 2025. Identification as a repeat finding, if applicable: This finding is a repeat finding from the prior year (2024-001, 2023-002). Recommendation: Management at Ascension Medical Group should reinforce the importance of adhering to its internal controls and timely review over the T&E certification reports. Views of responsible officials: Ascension Grants & Research Department will reinforce the importance of timely approval of Time & Effort reports with appropriate personnel at Saint Thomas Medical Partners.