Finding 1238289 (2025-004)

Material Weakness Repeat Finding
Requirement
B
Questioned Costs
-
Year
2025
Accepted
2026-09-29
Audit: 413143
Organization: Geisinger Health (PA)
Auditor: KPMG LLP

AI Summary

  • Core Issue: Geisinger claimed costs for COVID-19 pandemic response that were later deemed at risk of duplication with patient care revenue, leading to a reduction in federal funding.
  • Impacted Requirements: Compliance with FEMA's guidance on allowable costs and the need for effective internal controls to prevent duplication of benefits.
  • Recommended Follow-Up: Management should continuously monitor FEMA guidance and assess its impact on reported amounts for current and future federal awards.

Finding Text

Findings and Questioned Costs Relating to Federal Awards 2025-004: Compliance Requirements: Allowable Costs/Cost Principles Federal Granting Agency: U.S. Department of Homeland Security Award Name: Disaster Grants – Public Assistance (Presidentially Declared Disasters) Award Number: FEMA-4506-DR-PA Geisinger Project: 698009 Assistance Listing Number: 97.036 Award Year: Fiscal year 2025 Pass-through Entity: Commonwealth of Pennsylvania Emergency Management Agency Criteria: The terms and conditions for recipients of Disaster Grants - Public Assistance (Presidentially Declared Disasters) require that federal funds be used only for eligible emergency protective measures and other eligible work. Emergency work is defined as work that must be performed immediately to save lives, protect public health and safety, or avert or lessen the threat of a major disaster. Federal Emergency Management Agency (FEMA) guidance provides that claimed costs must be: • Directly tied to the performance of eligible work; • Adequately documented (2 CFR § 200.403(g)); • Reduced by all applicable credits and other sources of funding, including those that would result in a duplication of benefits (Stafford Act § 312; 42 U.S.C. § 5155; 2 CFR § 200.406); • Authorized and not prohibited under applicable laws and regulations; • Consistent with the entity’s established policies and procedures; and • Necessary and reasonable for the performance of the federal award (2 CFR § 200.403). In addition, 2 CFR § 200.303 requires non-federal entities receiving federal awards to establish and maintain effective internal controls that provide reasonable assurance of compliance with federal statutes, regulations, and the terms and conditions of federal awards. Condition: Geisinger made claims to the Federal Emergency Management Agency (FEMA) under the Disaster Grants - Public Assistance (Presidentially Declared Disasters) program for qualifying costs incurred to prepare for and respond to the COVID-19 pandemic. Geisinger’s applications and supporting documentation demonstrated that the claimed costs were incremental to its normal operating costs and were directly attributable to pandemic response activities. Geisinger prepared and submitted its claims in accordance with FEMA guidance available at that time. FEMA subsequently approved, obligated, and paid several projects. Accordingly, Risant reported approximately $615,555 on its Schedule of Expenditures of Federal Awards (SEFA) for the year ended December 31, 2025, based on amounts obligated by FEMA prior to FEMA’s duplication of benefits review. Following the approval and obligation of the projects, FEMA issued clarifying guidance related to patient care revenue duplication of benefits in December 2023 and subsequently performed a duplication of benefits analysis of Geisinger’s applications. On September 22, 2025, FEMA issued an Applicant Review Memo concluding that certain costs previously approved and obligated were at risk of duplication with patient care revenue. FEMA’s recommended reductions were based on its reassessment of previously approved claims utilizing the duplication of benefits methodology established in the clarifying guidance. Based on FEMA’s reassessment, Geisinger accepted FEMA’s determination and returned $72,763 related to one FEMA project obligated during 2025. Questioned Cost: $72,763 representing costs associated with the identified project that FEMA subsequently determined to be at risk of duplication of benefits and that Geisinger returned to FEMA during 2025. Repeat Finding in the Prior Year Not a repeat finding. Cause: FEMA issued clarifying guidance in December 2023 regarding the evaluation of potential duplication of benefits and subsequently performed a retrospective review of previously approved and obligated Geisinger projects. Effect: Costs previously approved and obligated by FEMA were subsequently determined to be at risk of duplication under FEMA’s revised duplication-of-benefits assessment methodology resulting in a reduction of previously awarded funding and federal expenditures reported on the SEFA. Recommendation: We recommend that management continue to monitor FEMA guidance related to COVID-19 Public Assistance funding and assess the impact of any subsequent FEMA determinations on amounts reported on the SEFA for existing and future awards. Views of Responsible Officials: Management agrees with the finding and the following corrective actions are being taken to minimize future risks. Management will continue to monitor FEMA guidance and determinations related to COVID-19 Public Assistance funding. Geisinger will evaluate the impact of subsequent FEMA reviews or determinations on amounts reported on the SEFA and adjust, as appropriate.

Corrective Action Plan

Finding: The terms and conditions for recipients of Disaster Grants - Public Assistance (Presidentially Declared Disasters) require that federal funds be used only for eligible emergency protective measures and other eligible work. Emergency work is defined as work that must be performed immediately to save lives, protect public health and safety, or avert or lessen the threat of a major disaster. Status: Management agrees with the finding and the following corrective actions were taken to minimize future risks. Management will continue to monitor FEMA guidance and determinations related to COVID-19 Public Assistance funding. Management will evaluate the impact of subsequent FEMA reviews or determinations on amounts reported on the SEFA and adjust, as appropriate. Contact Person: Erin Fitzgerald, VP Chief Accounting Officer Anticipated Completion Date: Q1 2026

Categories

Allowable Costs / Cost Principles Reporting Subrecipient Monitoring Matching / Level of Effort / Earmarking

Programs in Audit

ALN Program Name Expenditures
84.268 FEDERAL DIRECT STUDENT LOANS $20.77M
93.399 CANCER CONTROL $1.60M
21.027 CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY FUNDS $929,254
93.840 TRANSLATION AND IMPLEMENTATION SCIENCE RESEARCH FOR HEART, LUNG, BLOOD DISEASES, AND SLEEP DISORDERS $700,501
93.870 MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING GRANT $682,066
97.036 DISASTER GRANTS - PUBLIC ASSISTANCE (PRESIDENTIALLY DECLARED DISASTERS) $615,555
93.898 CANCER PREVENTION AND CONTROL PROGRAMS FOR STATE, TERRITORIAL AND TRIBAL ORGANIZATIONS $461,883
20.513 ENHANCED MOBILITY OF SENIORS AND INDIVIDUALS WITH DISABILITIES $456,000
93.810 PAUL COVERDELL NATIONAL ACUTE STROKE PROGRAM NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION $441,993
93.426 THE NATIONAL CARDIOVASCULAR HEALTH PROGRAM $416,762
93.732 MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING GRANTS $351,992
93.242 MENTAL HEALTH RESEARCH GRANTS $304,734
93.945 ASSISTANCE PROGRAMS FOR CHRONIC DISEASE PREVENTION AND CONTROL $293,096
84.063 FEDERAL PELL GRANT PROGRAM $285,912
93.243 SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES PROJECTS OF REGIONAL AND NATIONAL SIGNIFICANCE $272,063
93.884 PRIMARY CARE TRAINING AND ENHANCEMENT $219,789
93.359 NURSE EDUCATION, PRACTICE QUALITY AND RETENTION GRANTS $207,356
93.918 GRANTS TO PROVIDE OUTPATIENT EARLY INTERVENTION SERVICES WITH RESPECT TO HIV DISEASE $185,422
93.155 RURAL HEALTH RESEARCH CENTERS $166,476
93.110 SPECIAL PROJECTS OF REGIONAL AND NATIONAL SIGNIFICANCE $152,963
93.279 DRUG USE AND ADDICTION RESEARCH PROGRAMS $149,763
93.233 NATIONAL CENTER ON SLEEP DISORDERS RESEARCH $146,097
93.839 BLOOD DISEASES AND RESOURCES RESEARCH $141,561
93.107 AREA HEALTH EDUCATION CENTERS $132,655
93.136 INJURY PREVENTION AND CONTROL RESEARCH AND STATE AND COMMUNITY BASED PROGRAMS $125,667
93.866 AGING RESEARCH $111,737
10.001 AGRICULTURAL RESEARCH BASIC AND APPLIED RESEARCH $94,957
93.846 ARTHRITIS, MUSCULOSKELETAL AND SKIN DISEASES RESEARCH $93,628
93.310 TRANS-NIH RESEARCH SUPPORT $89,793
93.959 BLOCK GRANTS FOR PREVENTION AND TREATMENT OF SUBSTANCE ABUSE $87,569
93.847 DIABETES, DIGESTIVE, AND KIDNEY DISEASES EXTRAMURAL RESEARCH $84,150
93.859 BIOMEDICAL RESEARCH AND RESEARCH TRAINING $82,193
93.788 OPIOID STR $68,432
93.307 MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH $57,243
93.172 HUMAN GENOME RESEARCH $55,041
16.758 IMPROVING THE INVESTIGATION AND PROSECUTION OF CHILD ABUSE AND THE REGIONAL AND LOCAL CHILDREN'S ADVOCACY CENTERS $49,849
47.075 SOCIAL, BEHAVIORAL, AND ECONOMIC SCIENCES $45,368
93.837 CARDIOVASCULAR DISEASES RESEARCH $44,725
93.262 OCCUPATIONAL SAFETY AND HEALTH PROGRAM $37,725
93.917 HIV CARE FORMULA GRANTS $36,077
93.889 NATIONAL BIOTERRORISM HOSPITAL PREPAREDNESS PROGRAM $30,340
16.575 CRIME VICTIM ASSISTANCE $28,002
93.226 RESEARCH ON HEALTHCARE COSTS, QUALITY AND OUTCOMES $26,459
93.323 EPIDEMIOLOGY AND LABORATORY CAPACITY FOR INFECTIOUS DISEASES (ELC) $23,389
93.301 SMALL RURAL HOSPITAL IMPROVEMENT GRANT PROGRAM $23,058
93.153 COORDINATED SERVICES AND ACCESS TO RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND YOUTH $20,992
93.121 ORAL DISEASES AND DISORDERS RESEARCH $20,274
93.393 CANCER CAUSE AND PREVENTION RESEARCH $19,288
93.855 ALLERGY AND INFECTIOUS DISEASES RESEARCH $16,467
93.758 PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT FUNDED SOLELY WITH PREVENTION AND PUBLIC HEALTH FUNDS (PPHF) $14,606
93.865 CHILD HEALTH AND HUMAN DEVELOPMENT EXTRAMURAL RESEARCH $13,059
93.877 AUTISM COLLABORATION, ACCOUNTABILITY, RESEARCH, EDUCATION, AND SUPPORT $10,051
66.818 BROWNFIELDS MULTIPURPOSE, ASSESSMENT, REVOLVING LOAN FUND, AND CLEANUP COOPERATIVE AGREEMENTS $2,477
93.838 LUNG DISEASES RESEARCH $407
93.353 21ST CENTURY CURES ACT - BEAU BIDEN CANCER MOONSHOT $399
93.395 CANCER TREATMENT RESEARCH $317
93.853 EXTRAMURAL RESEARCH PROGRAMS IN THE NEUROSCIENCES AND NEUROLOGICAL DISORDERS $284