Finding 52049 (2022-001)

Material Weakness
Requirement
B
Questioned Costs
-
Year
2022
Accepted
2022-10-30
Audit: 52320
Organization: Cedar County Memorial Hospital (MO)

AI Summary

  • Core Issue: The Hospital lacks effective internal controls for reporting costs related to the Provider Relief Funding, particularly in documenting compliance with HHS guidelines.
  • Impacted Requirements: The Hospital failed to ensure that all reporting activities were properly documented, specifically regarding $1.2 million in emergency room physician costs related to Covid-19.
  • Recommended Follow-Up: Implement timely and sufficient documentation controls to justify costs incurred for Covid-19 response, addressing the uncertainty caused by changing guidance during the pandemic.

Finding Text

2022?001 Federal agency: U.S. Department of Health and Human Services Other Programs Federal program title: Provider Relief Funding CFDA Number: 93.498 Pass-Through Agency: N/A Pass-Through Number(s): N/A Award Period: Period 1 Type of Finding: Material Weakness in Internal Control over Compliance and Other Matters Compliance Requirement: Allowable Costs Criteria or specific requirement: Surrounding reporting activities, the Hospital?s internal controls should be designed to assure all reporting completed under program guidelines. Condition: During our testing, we identified the Hospital did not have internal controls and documentation procedures in place to ensure reporting was completed in accordance with HHS guidelines. Questioned costs: None Context: During our testing, it was identified that the Hospital reported approximately $1.2 Million in contracted emergency room physician costs, however at the time they did not specifically document how these costs were necessary to respond to Covid-19. Cause: The Hospital was amidst a pandemic and failed to document the rationale at the time of incurring the costs. Effect: The auditor noted no instances of noncompliance with the costs incurred; however, the internal controls around compliance over reporting were not effective. Repeat Finding: N/A Recommendation: We recommend the Hospital design controls to ensure documentation is completed timely and sufficiently on how costs are necessary to respond to Covid-19. Views of responsible officials: There is no disagreement with the audit finding. Management identified that given the changing guidance (incremental vs. non-incremental) and being in the midst of pandemic created uncertainty in the documentation requirements around the use of the funds. In addition, management believes there is approximately $374,000 of lost revenues that were inadvertently not included in the report.

Corrective Action Plan

FINDINGS? FINDINGS AND QUESTIONED COSTS ? MAJOR FEDERAL PROGRAMS DEPARTMENT OF HEALTH AND HUMAN SERVICES 2022 ? 001 COVID-19 Provider Relief Funding Recommendation: We recommend the Hospital design controls to ensure documentation is completed timely and sufficiently on how costs are necessary to respond to Covid-19. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Management did not believe it was necessary to document how contracted emergency room physician costs were necessary to prepare, prevent and respond to Covid-19. Name of the contact person responsible for corrective action: Carla Gilbert, CFO. Planned completion date for corrective action plan: January 31, 2023 If the Department of Health and Human Services has questions regarding this plan, please call Carla Gilbert, CFO at (417) 876-3097.

Categories

Allowable Costs / Cost Principles Material Weakness Reporting Internal Control / Segregation of Duties

Other Findings in this Audit

  • 628491 2022-001
    Material Weakness

Programs in Audit

ALN Program Name Expenditures
93.498 Provider Relief Fund $3.68M
21.019 Coronavirus Relief Fund $158,589
93.461 Covid-19 Testing for the Uninsured $86,981
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $66,395
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $51,711
93.697 Covid-19 Testing for Rural Health Clinics $49,461
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $39,064
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $21,949
93.069 Public Health Emergency Preparedness $16,826
93.994 Maternal and Child Health Services Block Grant to the States $8,236