Finding 537611 (2024-001)

Significant Deficiency
Requirement
I
Questioned Costs
$1
Year
2024
Accepted
2025-03-27
Audit: 348880
Organization: Boone Memorial Hospital, Inc. (WV)
Auditor: Forvis Mazars

AI Summary

  • Core Issue: Management did not obtain required price quotes for a $10,000 marketing service purchase, violating procurement regulations.
  • Impacted Requirements: Internal controls over procurement must include formal documentation and supervisory reviews to ensure compliance with regulations.
  • Recommended Follow-Up: Provide training for grants administration staff and enhance controls to ensure compliance with documentation and quote requirements for purchases over $10,000.

Finding Text

Assistance Listing #93.788 Opioid STR Significant Deficiency Criteria: The Uniform Guidance procurement regulations outlined in 2 CFR Part 200 Subpart D and applicable state and entity-level regulations require appropriate internal controls over the acquisition of goods and services to ensure compliance with such regulations, including maintaining formal written documentation of compliance with regulations depending on the dollar amount of purchase or for a non-competitive situation. Proper supervisory review controls to ensure compliance with such regulations are an important part of the internal control framework. Condition: During our procurement testing procedures, we noted a purchase of $10,000 for marketing services for which management failed to obtain and document compliance with the requirement to obtain price quotations from a reasonable number of qualified marketing service providers. Additionally, we noted an additional purchase for which management did not maintain contemporaneous formal written documentation supporting a non-competitive single source purchase. Management was later able to provide documentation supporting that this purchase met the qualifying requirements for a non-competitive situation. Cause: Management indicated that they did not obtain quotes for the marketing services as they felt that the quote obtained from the Hospital’s current external marketing service provider was reasonable in all material respects. Management noted that the failure to maintain contemporaneous documentation was an oversight due to turnover of various staff involved in the grants oversight process. Effect: Price quotations from a reasonable number of qualified service providers were not obtained for the purchased marketing services: thus, it is unknown if such services could have been provided for a lower amount. Questioned Costs: $10,000 Context: The population of expenses subject to procurement standards were sampled and a sample of two items greater than the micro-purchase threshold were selected for testing. Of those sampled, the one marketing purchase noted above was found to not be supported by quotes from a reasonable number of qualified sources. The sample was not considered statistically valid. Identification as a Repeat Finding: N/A Recommendation: The Hospital should ensure that individuals involved in the grants administration process receive the appropriate training to ensure their understanding of the Uniform Guidance, state and Hospital procurement requirements. For purchases greater than the micro-purchase threshold (i.e., $10,000 and greater), internal controls should be enhanced to ensure supervisory review for compliance with contemporaneous formal written documentation for quotes, bids, or qualification for non-competitive proposal requirements. Regulations specify at least three quotes from qualified sources, as applicable. Views of Responsible Officials: See corrective action plan.

Corrective Action Plan

As permitted by the West Virginia Department of Health, Health Facilities and Human Services’ (WVDHHFHS) State Opioid Response (SOR) General Operations Grant (G230821), Boone Memorial Hospital, Inc. (Hospital) acquired services through a local marketing and public relations agency that specialists in healthcare marketing. The services provided, totaled $10,000, included a video production session arranged by the local marketing agency, but provided by a sub-contracting service provider and social media editing services that were completed directly by the local marketing agency. All services provided were included on a single invoice submitted by the marketing agency for ease of payment for the Hospital. While we acknowledge the Hospital was not compliant with procurement regulations outlined by 2 CRF 200 Subpart D related to small purchase procedures, we believe the reported non-compliance is not material to the overall procurement associated with the above-mentioned grant. The engaged local healthcare marketing firm has provided services to the Hospital for several years. They also provide similar services to other hospitals throughout the region. The oppressed economic environment throughout the region limits the number of competitive vendors that provide healthcare specific marketing and public relations services throughout the area. Management believes that a healthcare focused service provider was the most appropriate solution for the services obtained and is confident that the developed relationship with the local service provider ensured competitive pricing. Also, since we utilize this agency for our external marketing services we believe that they gave us a reasonable and competitive price for the services provided, so we did not solicit bids from vendors that we have not previously utilized as we believe vendor pricing for a small one time project would be higher. As a result of the noted commentary, the following corrective actions will be taken to prevent future non-compliance: • Enhanced education around the Hospital’s established procurement procedures and the compliance requirements associated with the Uniform Guidance procurement regulations outlined in 2 CFR Part 200 Subpart D will be completed for individuals involved in the grants administration and individuals involved in the Hospital’s procurement process. • For service greater than the micro purchase threshold, we will maintain contemporaneous formal written documentation for quotes, bids, or qualification for non-competitive proposal requirements, as applicable. • When applicable, the Hospital will enhance internal controls and documentation to ensure supervisory review for compliance with federal procurement stands. Completion Date: June 30, 2025

Categories

Questioned Costs Procurement, Suspension & Debarment

Other Findings in this Audit

  • 1114053 2024-001
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.788 Opioid Str $1.21M
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $193,635
93.965 Coal Miners Respiratory Impairment Treatment Clinics and Services $122,631
93.165 Grants to States for Loan Repayment $30,000