Finding 1238771 (2025-002)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2025
Accepted
2026-09-30
Audit: 413721
Organization: Henry Ford Health System (MI)
Auditor: DELOITTE

AI Summary

  • Core Issue: Key personnel reduced their effort below the required 50%, failing to notify the federal agency as mandated.
  • Impacted Requirements: Noncompliance with 2 CFR § 200.308(f)(3) regarding prior approval for significant changes in personnel effort.
  • Recommended Follow-Up: Establish a control system to monitor personnel effort and ensure timely communication with the grantor for any reductions of 25% or more.

Finding Text

Finding 2025-002 Significant Deficiency in Controls over Compliance and Noncompliance – Special Tests Federal Program: 93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance Year: 2025 Federal Agency: Department of Health and Human Services Criteria – In Accordance with 2 CFR § 200.308(f)(3), the recipient must obtain prior written approval from the federal awarding agency or pass-through entity when the approved project director or principal investigator: - Disengages from the project for more than three continuous months; or - Reduces their committed time and effort by 25% or more from the level approved in the initial competing-year award Condition – The Contract ID 5H79SM083419 required the two key personnel to spend at least 50% level of Effort on the grant. We noted that the two key personnel spent 25% Level of effort and 15% level of effort, respectively, during the fiscal year which constituted a greater than 25% reduction in planned effort. Management did not submit an award amendment regarding the reduction in effort. Cause – Management did not adequately monitor the level of effort of the two key personnel on this Contract. Perspective – The grant program in aggregate had seven key personnel. Two key personnel's reduction in level of effort was not communicated via an amendment to the grantor. Questioned Cost – N/A Effect – Failure to properly notify the granting agency of the reduction in level of effort of key personnel could lead to the funding of this contract being ceased. Recommendation – Management should implement a control to track any reduction in level of effort and notify the grantor if there is a reduction of 25% or more. View of Responsible Officials – See Corrective Action Plan

Corrective Action Plan

Finding 2025-002 Significant Deficiency in Controls over Compliance and Noncompliance – Special Tests Federal Program: 93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance Year: 2025 Federal Agency: Department of Health and Human Services Condition – The Contract ID 5H79SM083419 required the two key personnel to spend at least 50% level of Effort on the grant. We noted that the two Key personnel spent 25% Level of effort and 15% level of effort, respectively, during the fiscal year which constituted a greater than 25% reduction in planned effort. Management did not submit an award amendment regarding the reduction in effort. Corrective Action Plan – Henry Ford Health agrees with this finding. Henry Ford Health will strengthen monitoring of key personnel effort commitments and enhance procedures to ensure significant reductions in effort are identified, reviewed, and communicated to the sponsoring agency when prior approval is required. Anticipated Completion Date – December 31, 2026. Contact Person – Doug Clark, Senior Vice President and Chief Accounting Officer.

Categories

Subrecipient Monitoring Significant Deficiency Matching / Level of Effort / Earmarking Special Tests & Provisions

Programs in Audit

ALN Program Name Expenditures
97.036 DISASTER GRANTS - PUBLIC ASSISTANCE (PRESIDENTIALLY DECLARED DISASTERS) $42.57M
21.027 CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY FUNDS $1.56M
93.143 NIEHS SUPERFUND HAZARDOUS SUBSTANCES_BASIC RESEARCH AND EDUCATION $545,192
93.846 ARTHRITIS, MUSCULOSKELETAL AND SKIN DISEASES RESEARCH $333,797
93.185 IMMUNIZATION RESEARCH, DEMONSTRATION, PUBLIC INFORMATION AND EDUCATION TRAINING AND CLINICAL SKILLS IMPROVEMENT PROJECTS $312,763
93.137 COMMUNITY PROGRAMS TO IMPROVE MINORITY HEALTH $263,114
93.361 NURSING RESEARCH $251,404
93.493 CONGRESSIONAL DIRECTIVES $248,998
93.380 THE CDC PUBLIC HEALTH CANCER GENOMICS PROGRAM: TRANSLATING RESEARCH INTO PUBLIC HEALTH PRACTICE $225,000
16.575 CRIME VICTIM ASSISTANCE $206,969
93.914 HIV EMERGENCY RELIEF PROJECT GRANTS $119,168
93.394 CANCER DETECTION AND DIAGNOSIS RESEARCH $110,910
93.855 ALLERGY AND INFECTIOUS DISEASES RESEARCH $103,953
10.561 STATE ADMINISTRATIVE MATCHING GRANTS FOR THE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM $77,539
98.001 USAID FOREIGN ASSISTANCE FOR PROGRAMS OVERSEAS $74,995
93.917 HIV CARE FORMULA GRANTS $72,059
93.840 TRANSLATION AND IMPLEMENTATION SCIENCE RESEARCH FOR HEART, LUNG, BLOOD DISEASES, AND SLEEP DISORDERS $70,968
93.092 AFFORDABLE CARE ACT (ACA) PERSONAL RESPONSIBILITY EDUCATION PROGRAM $69,208
93.988 COOPERATIVE AGREEMENTS FOR DIABETES CONTROL PROGRAMS $68,879
93.103 FOOD AND DRUG ADMINISTRATION RESEARCH $58,300
93.859 BIOMEDICAL RESEARCH AND RESEARCH TRAINING $52,072
93.398 CANCER RESEARCH MANPOWER $51,800
93.853 EXTRAMURAL RESEARCH PROGRAMS IN THE NEUROSCIENCES AND NEUROLOGICAL DISORDERS $49,733
93.113 ENVIRONMENTAL HEALTH $48,398
93.172 HUMAN GENOME RESEARCH $42,384
93.395 CANCER TREATMENT RESEARCH $39,281
93.838 LUNG DISEASES RESEARCH $29,735
93.226 RESEARCH ON HEALTHCARE COSTS, QUALITY AND OUTCOMES $28,634
93.421 STRENGTHENING PUBLIC HEALTH SYSTEMS AND SERVICES THROUGH NATIONAL PARTNERSHIPS TO IMPROVE AND PROTECT THE NATION€™S HEALTH $28,017
93.136 INJURY PREVENTION AND CONTROL RESEARCH AND STATE AND COMMUNITY BASED PROGRAMS $20,792
93.080 BLOOD DISORDER PROGRAM: PREVENTION, SURVEILLANCE, AND RESEARCH $20,363
93.977 SEXUALLY TRANSMITTED DISEASES (STD) PREVENTION AND CONTROL GRANTS $16,977
93.110 MATERNAL AND CHILD HEALTH FEDERAL CONSOLIDATED PROGRAMS $16,353
93.940 HIV PREVENTION AND SURVEILLANCE ACTIVITIES-HEALTH DEPARTMENT BASED $15,040
93.396 CANCER BIOLOGY RESEARCH $12,353
93.110 MATERNAL AND CHILD HEALTH FEERAL CONSOLIDATED PROGRAMS $8,787
93.837 CARDIOVASCULAR DISEASES RESEARCH $8,254
93.393 CANCER CAUSE AND PREVENTION RESEARCH $7,040
93.778 GRANTS TO STATES FOR MEDICAID $6,950
93.867 VISION RESEARCH $6,868
93.353 21ST CENTURY CURES ACT - BEAU BIDEN CANCER MOONSHOT $5,791
93.866 AGING RESEARCH $5,057
14.921 OLDER ADULTS HOME MODIFICATION GRANT PROGRAM $3,899
93.307 MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH $3,817
93.U00 FEDERAL CONTRACTS IN CANCER RESEARCH $3,710
12.420 MILITARY MEDICAL RESEARCH AND DEVELOPMENT $2,844
93.847 DIABETES, DIGESTIVE, AND KIDNEY DISEASES EXTRAMURAL RESEARCH $1,205
93.286 DISCOVERY AND APPLIED RESEARCH FOR TECHNOLOGICAL INNOVATIONS TO IMPROVE HUMAN HEALTH $557
93.243 SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES PROJECTS OF REGIONAL AND NATIONAL SIGNIFICANCE $0
93.865 CHILD HEALTH AND HUMAN DEVELOPMENT EXTRAMURAL RESEARCH $-1,815
93.273 ALCOHOL RESEARCH PROGRAMS $-4,608
64.U00 VETERAN AFFAIRS $-6,293
93.242 MENTAL HEALTH RESEARCH GRANTS $-7,026
93.233 NATIONAL CENTER ON SLEEP DISORDERS RESEARCH $-14,095
93.318 PROTECTING AND IMPROVING HEALTH GLOBALLY: BUILDING AND STRENGTHENING PUBLIC HEALTH IMPACT, SYSTEMS, CAPACITY AND SECURITY $-15,555
93.310 TRANS-NIH RESEARCH SUPPORT $-32,924
93.279 DRUG USE AND ADDICTION RESEARCH PROGRAMS $-102,187