Finding 504718 (2022-001)

Significant Deficiency Repeat Finding
Requirement
ABL
Questioned Costs
-
Year
2022
Accepted
2024-11-05
Audit: 327330
Organization: Inova Health System (VA)

AI Summary

  • Core Issue: There are significant deficiencies in internal controls over the COVID-19 Provider Relief Fund expenditures, leading to potential inaccuracies in HRSA portal submissions.
  • Impacted Requirements: Compliance with Title 2 U.S. Code of Federal Regulations, Part 200.303, which mandates effective internal controls for managing federal awards.
  • Recommended Follow-Up: Management should establish and document internal controls for reviewing expenditure allowability and ensure experienced personnel prepare and review HRSA reports before submission.

Finding Text

Federal Program Information Federal Agencies: Department of Health and Human Services (“HHS”) Awards: Assistance Listing Number 93.498 COVID 19 – Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Award Periods: Period 3 – January 1, 2021 to June 30, 2022 Period 4 – June 30, 2021 to December 31, 2022 Description: Review and Approval of the expenditures included in the HRSA portal submission Type of Finding: Significant Deficiency in Internal Control Over Compliance Criteria In accordance with Title 2 U.S. Code of Federal Regulations, Part 200.303, Internal controls, “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.” The terms and conditions of the award require the recipient to submit reports as the secretary of HHS determines are needed to ensure compliance with conditions that are imposed on the payment, and such reports shall be in such form, with such content, as specified by the secretary of HHS in future program instructions directed to all recipients. Condition The System did not have appropriately designed internal controls in place over the COVID 19 Provider Relief Fund (“PRF”) grant awards related to the review and approval of the expenditures included in the U.S. Health Resources and Services Administration (“HRSA”) portal submission. Cause Management did not design internal controls or retain evidence of review and approval of the allowability of expenditures submitted within the HRSA portal. Effect or potential effect The expenditures included in the HRSA portal submission could be inaccurate or information reported to HRSA portal may be incomplete or inaccurate. Questioned costs None. Identification of a repeat finding This is a repeat finding and relates to prior year finding 2021-002. Context The System submitted a total of 9 reports within the HRSA portal during Period 3 and Period 4. The total PRF payments received by the System was $12,424,630. We tested 5 HRSA portal submissions that had total payments from HRSA amount to $11,977,661. Management did not retain documentation to support review and approval of the allowability of the expenditures entered in the HRSA portal. Audit procedures identified no questioned costs as it related to expenditures included within the HRSA portal submission. Recommendation Management should design internal controls related to the review of the allowability of expenditures for the HRSA portal submission to ensure that the reported amounts are accurate and retain evidence of this review. View of responsible officials Management concurs with the finding and will implement procedures to ensure that HRSA reporting reports are prepared by individuals with HRSA reporting experience and reviewed by management prior to submission.

Corrective Action Plan

Federal Program Information: Federal Agency: U.S. Department of Health and Human Services Awards: Assistance Listing Number 93.498 COVID-19 – Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Award Periods: Period 3 – January 1, 2021 to June 30, 2022 Period 4 – June 30, 2021 to December 31, 2022 Description: Review and Approval of the expenditures included in the HRSA portal submission Type of Finding: Significant Deficiency in Internal Control Over Compliance Recommendation: Management should design internal controls related to the documentation of the review of the expenditures for the HRSA portal submission to ensure that the reported amounts are accurate. View of Responsible Officials: Management concurs with the finding and will implement procedures to ensure that HRSA reporting reports are prepared by individuals with HRSA reporting experience and reviewed by management prior to submission. Name(s) of the Contact Person(s) Responsible for Corrective Action: Christopher T. Smith, Vice President of Finance and Corporate Controller, 571-472-8122. Christopher Trump, Senior Director of Financial Reporting, 571-373-2868. Michael H. Lowen, Director, Grant Accounting, 571-472-8108. Corrective Action Planned: Activities Allowed or Unallowed, Allowable Costs/Cost Principles - Inova has an established process that identifies actions needed to carry out specific responses to identified internal control risks related to the review of the expenditures for the HRSA portal submissions, specifically that the reported amounts are accurate. Part of that process is to review the HRSA portal submissions for specific allowable activities requirements, and those activities/costs that require pre-approval by the awarding agency. Additionally, monthly, the Director of Grants Accounting reviews the budget versus actual reports investigating unusual or unexpected variances and documents results of follow-up work performed. In order to improve both of these processes and ensure more accurate reviews, Inova’s Director of Grants Accounting will develop a training program that ensures a timely cadence, of no less than bi-annually, whereby all applicable personnel obtain current knowledge of allowable activities and associated costs to be submitted to HRSA and other governing agencies as deemed appropriate. The program will include self-guided training in addition to enlisting industry experts to instruct on relevant updates. External trainings will be documented either electronically, if so allowed, or through properly recorded minutes. Reporting - Management will identify, and put into effect, actions needed to carry out specific responses to identified risks related to reporting. Such actions will include enhancing current knowledge of reporting requirements through a training program as discussed above, develop and document all controls over reporting that were leveraged to create and review manually prepared spreadsheets and reports. Prior to the HRSA portal submissions, our review process, as identified above, will be formally documented and evidenced by proper signoffs. Further, we will also address segregation of duties concerns that will alleviate risk of fraud and develop and appropriately document bridge between source data and final reports for any reconciling items and lack of or inappropriate source data or analysis used as the basis of reporting. Inova management will review, and periodically update applicable award agreements or contracts for specific reporting requirements and establish a reporting calendar for review and approval. The calendar will be periodically reviewed with the Grants Management Office (“GMO”) for the completeness and accuracy of and adherence to the reporting calendar. Written policies and procedures will be created outlining processes and control activities for ensuring reporting to federal awarding agencies and pass-through entities are complete and accurate. Planned Completion Date for Corrective Action Planned: Ongoing with a completion date of December 31, 2023.

Categories

Reporting Significant Deficiency Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

Other Findings in this Audit

  • 504719 2022-002
    Material Weakness
  • 504720 2022-003
    Significant Deficiency Repeat
  • 504721 2022-004
    Material Weakness
  • 1081160 2022-001
    Significant Deficiency Repeat
  • 1081161 2022-002
    Material Weakness
  • 1081162 2022-003
    Significant Deficiency Repeat
  • 1081163 2022-004
    Material Weakness

Programs in Audit

ALN Program Name Expenditures
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $31.63M
93.498 Provider Relief Fund and American Rescue Plan (arp) Rural Distribution $12.42M
93.917 Hiv Care Formula Grants $3.05M
12.750 Uniformed Services University Medical Research Projects $2.36M
93.837 Cardiovascular Diseases Research $728,686
93.153 Coordinated Services and Access to Research for Women, Infants, Children, and Youth $630,893
93.918 Grants to Provide Outpatient Early Intervention Services with Respect to Hiv Disease $551,228
93.461 Hrsa Covid-19 Claims Reimbursement for the Uninsured Program and the Covid-19 Coverage Assistance Fund $537,317
93.939 Hiv Prevention Activities Non-Governmental Organization Based $428,237
20.RD Nhtsa Discretionary Safety Grants and Cooperative Agreements $358,219
93.350 National Center for Advancing Translational Sciences $278,879
93.145 Aids Education and Training Centers $249,634
93.RD Population Health Research Support $203,128
93.914 Hiv Emergency Relief Project Grants $168,245
93.767 Children's Health Insurance Program $166,981
93.353 21st Century Cures Act - Beau Biden Cancer Moonshot $144,695
93.103 Food and Drug Administration Research $134,239
16.575 Crime Victim Assistance $126,935
93.393 Cancer Cause and Prevention Research $102,253
93.RD Nhlbi Graft Sample and Data Collection Project $80,705
93.394 Cancer Detection and Diagnosis Research $73,677
12.420 Military Medical Research and Development $40,278
93.226 Research on Healthcare Costs, Quality and Outcomes $35,161
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $32,135
93.RD Nhlbi/inova Pulmonary Vascular Program $27,759
93.397 Cancer Centers Support Grants $21,633
93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders $17,834
21.027 Coronavirus State and Local Fiscal Recovery Funds $13,427
93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research $13,326
93.RD Nhlbi Pulmonary Vascular Program $7,240
93.855 Allergy and Infectious Diseases Research $5,536
93.RD Support Services for the Lampoon Protocol Ide Enrollment Sites $4,248
93.940 Hiv Prevention Activities Health Department Based $2,126