Finding 390045 (2023-002)

Significant Deficiency
Requirement
P
Questioned Costs
-
Year
2023
Accepted
2024-03-29
Audit: 300905
Organization: Ballad Health (TN)
Auditor: Pya PC

AI Summary

  • Core Issue: Ballad did not have proper controls to ensure the Schedule of Expenditures of Federal Awards (SEFA) was accurate, leading to overstatements of federal expenditures.
  • Impacted Requirements: This finding violates 2 CFR 200.510 and 200.303, which mandate accurate reporting and effective internal controls over federal awards.
  • Recommended Follow-Up: Implement formal procedures for SEFA preparation and provide training to staff involved in its creation and review to ensure compliance.

Finding Text

This section identifies the audit findings required to be reported by 2 CFR 200 Section 516(a) of the Uniform Guidance (for example, significant deficiencies, material weaknesses, and material instances of noncompliance, including questioned costs), as well as any abuse findings involving federal awards that are material to a major program. 2023-002 Preparation of Schedule of Expenditures of Federal Awards Identification of the Federal Programs: Assistance Listing Number (ALN) - 93.788 Opioid STR, from the U.S. Department of Health and Human Services passed through from the State of Tennessee Department of Mental Health and Substance Abuse Services, and ALN - 97.036 U.S. Department of Homeland Security - Disaster Grants - Public Assistance (Presidentially Declared Disasters). Criteria: 2 CFR 200.510 of the Uniform Guidance indicates that the auditee must prepare a schedule of expenditures of federal awards (SEFA) for the period covered by the auditee’s financial statements which must include the total federal awards expended as determined in accordance with 200.502, Basis for Determining Federal Awards Expended. Per 2 CFR 200.502, the determination of when a federal award is expended should be based on when the activity related to the federal award occurs. In addition, 2 CFR Part 200.303 requires the entity to establish and maintain effective internal controls over federal awards that provides reasonable assurance of compliance with federal statutes, regulations, and the terms and conditions of federal awards. Condition: Ballad did not have adequate controls in place to ensure the SEFA was accurate. The initial draft of the SEFA included expenditures for ALN - 93.788 that were accidentally “double-counted” in the SEFA. This resulted in expenditures on the SEFA being overstated by $188,242 for this program. The initial draft of the SEFA also included expenditures for ALN - 97.036 that were amounts required to be returned to the grantor agency and not expenditures. This resulted in expenditures on the SEFA being overstated by $312,092 for this program. Revisions to the SEFA were required to accurately present the federal expenditures for the period. Cause of Condition: Ballad did not perform an adequate review of the prepared SEFA and did not implement procedures to ensure the amounts recorded were complete and accurate in relation to the consolidated financial statements. Effect: If not corrected, inaccurate expenditures would have been reported to the federal government. In addition, the errors could result in improper selection of major program(s) for the Uniform Guidance audit. Context: There are no questioned costs associated with this finding. Auditor’s Recommendation: Ballad should establish formal procedures for determination of federal expenditures for inclusion in the SEFA. We further recommend training for those involved in the preparation and review of the SEFA to ensure that they are fully aware of the requirements related to SEFA preparation. Views of Responsible Officials and Planned Corrective Actions: Ballad Health will utilize technology efficiencies within upgraded accounting system to supplement reporting. Additionally, a resource will be added directly responsible for grant accounting. The SEFA will also be reviewed frequently to ensure accuracy.

Categories

Reporting

Other Findings in this Audit

  • 390042 2023-002
    Significant Deficiency
  • 390043 2023-002
    Significant Deficiency
  • 390044 2023-002
    Significant Deficiency
  • 390046 2023-002
    Significant Deficiency
  • 390047 2023-002
    Significant Deficiency
  • 966484 2023-002
    Significant Deficiency
  • 966485 2023-002
    Significant Deficiency
  • 966486 2023-002
    Significant Deficiency
  • 966487 2023-002
    Significant Deficiency
  • 966488 2023-002
    Significant Deficiency
  • 966489 2023-002
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.498 Provider Relief Fund $51.44M
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $3.23M
21.027 Coronavirus State and Local Fiscal Recovery Funds $1.12M
93.788 Opioid Str $1.03M
93.558 Temporary Assistance for Needy Families $507,697
93.697 Covid-19 Testing for Rural Health Clinics $431,045
93.778 Medical Assistance Program $290,750
93.074 Hopsital Preparedness Program An D Public Health Emergency Preparedness Aligned Cooperative Agreements $250,000
16.575 Crime Victim Assistance $190,070
93.155 Rural Health Research Centers $152,155
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $147,049
93.650 Accountable Health Communities $138,956
17.289 Community Project Funding/congressionally Directed Spending $129,181
93.495 Community Health Workers for Public Health Response and Resilient $116,922
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $71,368
93.297 Teenage Pregnancy Prevention Program $39,827
97.008 Non-Profit Security Program $38,445
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $15,275
20.616 National Priority Safety Programs $14,771
23.002 Appalachian Development Highway System $14,400
93.575 Child Care and Development Block Grant $14,000
18.181A Special Education-Grants for Infants and Families $10,769
93.301 Small Rural Hospital Improvement Grant Program $10,103
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $6,995
93.889 National Bioterrorism Hospital Preparedness Program $6,911