Finding 25817 (2022-004)

-
Requirement
B
Questioned Costs
$1
Year
2022
Accepted
2023-02-07
Audit: 27397
Organization: Cherry County Hospital (NE)
Auditor: Seim Johnson LLP

AI Summary

  • Core Issue: Certain expenses reported for the Provider Relief Fund were not adjusted for amounts reimbursed by Medicare and Medicaid, violating the CARES Act terms.
  • Impacted Requirements: Funds must not cover expenses already reimbursed by other sources, leading to questioned costs of $91,650.
  • Recommended Follow-Up: Management should improve internal controls to ensure only eligible costs are reported and prevent double-dipping on reimbursements.

Finding Text

Identification of the Federal Program: Federal Assistance Listing Number 93.498 US Department of Health and Human Services Provider Relief Fund Criteria or Specific Requirement: The terms and conditions of the CARES Act Provider Relief Fund (PRF) distributions state that funds are not to be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. Condition: During the process of identifying expenses that were incurred to prevent, prepare for or respond to the coronavirus pandemic, certain expenses that were reported in the PRF submission were not reduced by amounts reimbursed by other sources. Cause: Due to the amount of detailed information that was required to be compiled by management in order to enter data into the PRF reporting portal, management inadvertently included in eligible expenses certain expenses that were also reimbursed by Medicare and Medicaid through cost-based reimbursement. Effect or Potential Effect: Management included amounts in the PRF reporting portal which were not eligible based on the terms and conditions of the PRF distributions. Questioned Costs: Total questioned costs related to Federal Assistance Listing Number 93.498 amounted to $91,650 and were calculated based off the underlying expense detail management used to populate the PRF reporting portal and the estimate Medicare and Medicaid cost-based reimbursement percentage. Context: The PRF and HRSA guidance states that costs cannot be used to reimburse expenses or losses that have been or are obligated to be reimbursed by other sources. Certain fringe benefit expenses were identified as being claimed for reimbursement through both the PRF reporting portal submission, and cost-based reimbursement from Medicare and Medicaid. Recommendation: We recommend that management continue to monitor and enhance its internal controls over federal award compliance to ensure that only eligible costs are included in amounts expended and that the same expenses are not for multiple grant awards. Views of Responsible Officials and Planned Corrective Actions: Management agrees with the noted finding. However, the Hospital had also incurred sufficient lost revenue that if the noted questioned costs had not been reported, the Hospital would have satisfactorily incurred eligible expenses in excess of the PRF funds received, including interest earned on such funds.

Corrective Action Plan

Item 2022-004 Condition: During the process of identifying expenses that were incurred to prevent, prepare for or respond to the coronavirus pandemic, certain expenses that were reported in the PRF submission were not reduced by amounts reimbursed by other sources. Planned Corrective Action: Management agrees with the noted finding. However, the Hospital had also incurred sufficiency lost revenue that if the noted questioned costs had not been reported, the Hospital would have satisfactorily incurred eligible expenses in excess of the PRF funds received, including interest earned on such funds. Management will continue to refine processes to more diligently review expenses to ensure that expenses are not being utilized for reimbursement from multiple sources. Contact Person: Amanda Davidson, Chief Financial Officer Anticipated Completion Date: Ongoing

Categories

Questioned Costs Cash Management Reporting

Other Findings in this Audit

  • 25818 2022-005
    Significant Deficiency
  • 602259 2022-004
    -
  • 602260 2022-005
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.498 Provider Relief Fund $4.05M
93.461 Covid-19 Claims Reimbursement for the Uninsured Program and the Covid-19 Coverage Assistance Fund $57,452
93.697 Covid-19 Testing and Mitigation for Rural Health Clinics $49,461
93.301 Small Rural Hospital Improvement Grant Program $11,855