FAC Explorer

Finding 29699 (2022-004)

Significant Deficiency
Requirement
L
Questioned Costs
-
Year
2022
Accepted
2023-03-08
Audit: 25088
Organization: Ascension Health Alliance D/b/a Ascension (MO)
Auditor: Ernst & Young

AI Summary

  • Core Issue: Timely submission of required financial reports for the COVID-19 federal program was not met due to lack of internal controls.
  • Impacted Requirements: Compliance with Section 200.303 of the Uniform Guidance regarding internal control over federal awards was not achieved.
  • Recommended Follow-Up: Implement a monitoring system for report due dates to ensure timely submissions; a team calendar has already been established for this purpose.

Finding Text

Information of the federal program: Federal Grantor: United States Department of the Treasury Assistance Listing No.: 21.027, COVID-19 Coronavirus State and Local Fiscal Recovery Funds Pass-Through Grantor: State of Tennessee Department of Health Ascension Ministry Market: Tennessee Pass-Through Award Number: 34352-93122, 34352-90022, 34352-69822 Pass-Through Award Period: 07/06/2021?Ongoing Pass-Through Grantor: Michigan Health & Hospital Association Ascension Ministry Market: Michigan Pass-Through Award Number: Not applicable Pass-Through Award Period: 12/01/2021?09/30/2023 Pass-Through Grantor: Kansas Department of Health & Environment Ascension Ministry Market: Kansas Pass-Through Award Number: Not applicable Pass-Through Award Period: 09/01/2021?02/28/2022 Criteria or specific requirement (including statutory, regulatory or other citation): Section 200.303 of the Uniform Guidance states the following regarding internal control: ?The non-Federal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with 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).? The terms and conditions of the pass-through agreements with the states required the submission of the following special reports during the fiscal year:(see Schedule of Findings and Questioned Cost for chart/table). Condition: The Policy 3 Financial Reports required by the State of Tennessee Department of Health were not submitted timely for certain time periods during fiscal year 2022. Cause: Internal controls were not in place to monitor the due dates for submission of special reports under the pass-through agreement with the State of Tennessee Department of Health. Effect or potential effect: The System may not be in compliance with the terms and conditions of the federal program reporting requirements. Questioned costs: None. Context: We sampled 9 special reports out of a population of 51 required to be submitted under the federal program for the System?s Kansas, Michigan, and Tennessee locations. Two of the nine (22%) special reports were not submitted timely. The quarterly special reports that were due on October 31, 2021, and January 30, 2022, were both submitted to the State of Tennessee Department of Health on April 4, 2022. For Assistance Listing No. 21.027, expenditures for the Tennessee location were $4,135,064, which represents approximately 13.6% of total federal expenditures of $30,499,780 reported in the SEFA for the year ended June 30, 2022. Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. Recommendation: The System should implement an internal control over the monitoring of due dates of all reports required to be submitted under the federal program to ensure they are submitted timely. Views of responsible officials: As of February 1, 2023, Ascension has implemented a team calendar that tracks due dates of all reports required to be submitted under federal programs. This calendar is accessible to all team members, including management, for oversight and accountability.

Categories

Reporting Internal Control / Segregation of Duties Subrecipient Monitoring Matching / Level of Effort / Earmarking

Other Findings in this Audit

  • 29649 2022-004
    Significant Deficiency
  • 29650 2022-005
    Material Weakness
  • 29651 2022-003
    Significant Deficiency
  • 29652 2022-004
    Significant Deficiency
  • 29653 2022-005
    Material Weakness
  • 29654 2022-004
    Significant Deficiency
  • 29655 2022-005
    Material Weakness
  • 29656 2022-004
    Significant Deficiency
  • 29657 2022-005
    Material Weakness
  • 29658 2022-004
    Significant Deficiency
  • 29659 2022-005
    Material Weakness
  • 29660 2022-003
    Significant Deficiency
  • 29661 2022-004
    Significant Deficiency
  • 29662 2022-005
    Material Weakness
  • 29663 2022-003
    Significant Deficiency
  • 29664 2022-004
    Significant Deficiency
  • 29665 2022-005
    Material Weakness
  • 29666 2022-003
    Significant Deficiency
  • 29667 2022-004
    Significant Deficiency
  • 29668 2022-005
    Material Weakness
  • 29669 2022-003
    Significant Deficiency
  • 29670 2022-004
    Significant Deficiency
  • 29671 2022-005
    Material Weakness
  • 29672 2022-003
    Significant Deficiency
  • 29673 2022-004
    Significant Deficiency
  • 29674 2022-005
    Material Weakness
  • 29675 2022-004
    Significant Deficiency
  • 29676 2022-005
    Material Weakness
  • 29677 2022-003
    Significant Deficiency
  • 29678 2022-004
    Significant Deficiency
  • 29679 2022-005
    Material Weakness
  • 29680 2022-003
    Significant Deficiency
  • 29681 2022-004
    Significant Deficiency
  • 29682 2022-005
    Material Weakness
  • 29683 2022-004
    Significant Deficiency
  • 29684 2022-005
    Material Weakness
  • 29685 2022-004
    Significant Deficiency
  • 29686 2022-005
    Material Weakness
  • 29687 2022-004
    Significant Deficiency
  • 29688 2022-005
    Material Weakness
  • 29689 2022-003
    Significant Deficiency
  • 29690 2022-004
    Significant Deficiency
  • 29691 2022-005
    Material Weakness
  • 29692 2022-003
    Significant Deficiency
  • 29693 2022-004
    Significant Deficiency
  • 29694 2022-005
    Material Weakness
  • 29695 2022-003
    Significant Deficiency
  • 29696 2022-004
    Significant Deficiency
  • 29697 2022-005
    Material Weakness
  • 29698 2022-003
    Significant Deficiency
  • 29700 2022-005
    Material Weakness
  • 29701 2022-003
    Significant Deficiency
  • 29702 2022-004
    Significant Deficiency
  • 29703 2022-005
    Material Weakness
  • 29704 2022-004
    Significant Deficiency
  • 29705 2022-005
    Material Weakness
  • 29706 2022-001
    Material Weakness Repeat
  • 29707 2022-002
    Significant Deficiency Repeat
  • 606091 2022-004
    Significant Deficiency
  • 606092 2022-005
    Material Weakness
  • 606093 2022-003
    Significant Deficiency
  • 606094 2022-004
    Significant Deficiency
  • 606095 2022-005
    Material Weakness
  • 606096 2022-004
    Significant Deficiency
  • 606097 2022-005
    Material Weakness
  • 606098 2022-004
    Significant Deficiency
  • 606099 2022-005
    Material Weakness
  • 606100 2022-004
    Significant Deficiency
  • 606101 2022-005
    Material Weakness
  • 606102 2022-003
    Significant Deficiency
  • 606103 2022-004
    Significant Deficiency
  • 606104 2022-005
    Material Weakness
  • 606105 2022-003
    Significant Deficiency
  • 606106 2022-004
    Significant Deficiency
  • 606107 2022-005
    Material Weakness
  • 606108 2022-003
    Significant Deficiency
  • 606109 2022-004
    Significant Deficiency
  • 606110 2022-005
    Material Weakness
  • 606111 2022-003
    Significant Deficiency
  • 606112 2022-004
    Significant Deficiency
  • 606113 2022-005
    Material Weakness
  • 606114 2022-003
    Significant Deficiency
  • 606115 2022-004
    Significant Deficiency
  • 606116 2022-005
    Material Weakness
  • 606117 2022-004
    Significant Deficiency
  • 606118 2022-005
    Material Weakness
  • 606119 2022-003
    Significant Deficiency
  • 606120 2022-004
    Significant Deficiency
  • 606121 2022-005
    Material Weakness
  • 606122 2022-003
    Significant Deficiency
  • 606123 2022-004
    Significant Deficiency
  • 606124 2022-005
    Material Weakness
  • 606125 2022-004
    Significant Deficiency
  • 606126 2022-005
    Material Weakness
  • 606127 2022-004
    Significant Deficiency
  • 606128 2022-005
    Material Weakness
  • 606129 2022-004
    Significant Deficiency
  • 606130 2022-005
    Material Weakness
  • 606131 2022-003
    Significant Deficiency
  • 606132 2022-004
    Significant Deficiency
  • 606133 2022-005
    Material Weakness
  • 606134 2022-003
    Significant Deficiency
  • 606135 2022-004
    Significant Deficiency
  • 606136 2022-005
    Material Weakness
  • 606137 2022-003
    Significant Deficiency
  • 606138 2022-004
    Significant Deficiency
  • 606139 2022-005
    Material Weakness
  • 606140 2022-003
    Significant Deficiency
  • 606141 2022-004
    Significant Deficiency
  • 606142 2022-005
    Material Weakness
  • 606143 2022-003
    Significant Deficiency
  • 606144 2022-004
    Significant Deficiency
  • 606145 2022-005
    Material Weakness
  • 606146 2022-004
    Significant Deficiency
  • 606147 2022-005
    Material Weakness
  • 606148 2022-001
    Material Weakness Repeat
  • 606149 2022-002
    Significant Deficiency Repeat

Programs in Audit

ALN Program Name Expenditures
93.498 Covid-19 Provider Relief Fund and American Rescue Plan (arp) Rual Distribution $687.51M
93.461 Covid-19 Hrsa Covid-19 Claims Reimbursement for the Uninsured Program and the Covid-19 Coverage Assistance Fund $39.06M
21.027 Covid-19 Coronavirus State and Local Fiscal Recovery Funds $7.52M
93.600 Head Start $1.30M
93.268 Covid-19 Immunization Cooperative Agreements $713,140
93.959 Block Grants for Prevention and Treatment of Substance Abuse $574,767
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $424,025
21.019 Covid-19 Coronavirus Relief Fund $404,980
93.697 Covid-19 Testing and Mitigation for Rural Health Clinics $383,133
93.399 Cancer Control $375,886
93.558 Temporary Assistance for Needy Families $374,505
93.788 Opioid Str $355,740
93.650 Accountable Health Communities $332,142
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance $330,787
84.181 Special Education-Grants for Infants and Families $328,353
16.575 Crime Victim Assistance $281,799
93.155 Covid-19 Rural Health Research Centers $255,876
14.195 Section 8 Housing Assistance Payments Program $228,815
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $217,385
93.323 Covid-19 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $215,941
93.575 Covid-19 Child Care and Development Block Grant $214,122
93.958 Block Grants for Community Mental Health Services $196,242
93.048 Special Programs for the Aging, Title Iv, and Title Ii, Discretionary Projects $184,116
93.332 Cooperative Agreement to Support Navigators in Federally-Facilitated Exchanges $171,705
10.331 Covid-19 Food Insecurity Nutrition Incentive Grants Program $147,347
93.600 Covid-19 Head Start $134,317
14.241 Housing Opportunities for Persons with Aids $128,861
17.720 Disability Employment Policy Development $124,958
14.267 Continuum of Care Program $117,859
93.839 Blood Diseases and Resources Research $108,426
93.837 Cardiovascular Diseases Research $105,801
20.600 State and Community Highway Safety $105,332
93.301 Covid-19 Small Rural Hospital Improvement Grant Program $95,699
17.207 Employment Service/wagner-Peyser Funded Activities $88,008
93.074 Hospital Preparedness Program (hpp) and Public Health Emergency Preparedness (phep) Aligned Cooperative Agreements $79,613
93.917 Hiv Care Formula Grants $72,652
14.191 Multifamily Housing Service Coordinators $65,962
93.686 Ending the Hiv Epidemic: A Plan for America - Ryan White Hiv/aids Program Parts A and B $65,404
14.157 Supportive Housing for the Elderly $64,990
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $64,368
93.667 Social Services Block Grant $61,080
93.994 Maternal and Child Health Services Block Grant to the States $60,780
16.607 Bulletproof Vest Partnership Program $59,096
93.395 Cancer Treatment Research $56,432
93.889 Covid-19 National Bioterrorism Hospital Preparedness Program $42,050
16.585 Drug Court Discretionary Grant Program $36,710
93.914 Hiv Emergency Relief Project Grants $30,000
93.310 Trans-Nih Research Support $28,000
10.558 Child and Adult Care Food Program $27,818
93.247 Advanced Nursing Education Workforce Grant Program $23,129
93.273 Alcohol Research Programs $21,374
93.426 Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke $20,000
93.940 Hiv Prevention Activities Health Department Based $20,000
10.555 National School Lunch Program $19,343
93.110 Maternal and Child Health Federal Consolidated Programs $19,090
93.478 Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees $15,150
93.080 Blood Disorder Program: Prevention, Surveillance, and Research $14,741
93.361 Nursing Research $14,507
93.301 Small Rural Hospital Improvement Grant Program $11,915
93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders $11,244
12.420 Military Medical Research and Development $10,817
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $9,992
16.034 Covid-19 Coronavirus Emergency Supplemental Funding Program $8,639
93.865 Child Health and Human Development Extramural Research $2,380
10.545 Covid-19 Farmers' Market Supplemental Nutrition Assistance Program Support Grants $1,818
93.669 Child Abuse and Neglect State Grants $1,200
93.556 Marylee Allen Promoting Safe and Stable Families Program $1,023
93.083 Prevention of Disease, Disability, and Death Through Immunization and Control of Respiratory and Related Diseases $617
93.855 Allergy and Infectious Diseases Research $162