Finding 588747 (2022-001)

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Requirement
L
Questioned Costs
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Year
2022
Accepted
2023-09-27
Audit: 16670
Organization: Ahs Hospital Corp. (NJ)

AI Summary

  • Core Issue: The Hospital incorrectly calculated lost revenues using Option (ii) due to not having approved budgets for 2021 and 2022 before the required date.
  • Impacted Requirements: HRSA guidelines mandate that budgets must be approved prior to March 27, 2020, for recipients using Option (ii) for lost revenue calculations.
  • Recommended Follow-Up: Implement internal controls for HRSA guidance review and contact HRSA for corrective actions regarding the reporting error.

Finding Text

2022-001: Provider Relief Fund Reporting Cluster: Not applicable Federal Granting Agency: DHHS Health Resources and Services Administration (?HRSA?) Award Name: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing Number: 93.498 Assistance Listing Title: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Award Year: January 1, 2020 ? December 31, 2022 Criteria Step 13 ? Lost Revenues of the HRSA User Guide for Provider Relief Fund (PRF) Reporting Portal ? Reporting dated June 30, 2022 requires Reporting entities (recipients) that apply PRF payments toward lost revenues to use one of the following three options for calculating lost revenues: ? Option (i): difference between 2019 actual patient care revenues and actuals for each quarter during the period of availability; ? Option (ii): difference between budgeted and actual patient care revenues for each quarter during the period of availability; or ? Option (iii): any reasonable method of estimating revenues. Per the HRSA User Guide, recipients that select Option (ii) must submit documentation of budgets approved prior to March 27, 2020 that covers the entire period of availability. Condition The Hospital completed its Period 3 PRF Reporting Portal submissions and attested to calculating lost revenues using Option (ii). However, in order to use this option, budgets covering the entire period of availability (January 1, 2020 to December 31, 2022) were required to be approved prior to March 27, 2020. While the budget of the Hospital for the year ended December 31, 2020 was approved prior to this date, budgets for the remaining period of availability (calendar years 2021 and 2022) were not approved prior to March 27, 2020. Cause The Hospital?s budgets for the years ended December 31, 2021 and 2022 were not approved prior to March 27, 2020. Effect The Hospital?s selection of Option (ii) to calculate lost revenue in accordance with the June 11, 2021 PRF General and Targeted Distribution Post-Payment Notice of Reporting Requirements was not appropriate for its Period 3 PRF Reporting Portal Submission. The amount of lost revenues reported as the difference between budgeted and actual patient care revenues for the year ended December 31, 2020 were far in excess of the funds received (both in Period 3 and cumulatively to date through Period 3). Questioned Costs None noted. Recommendation: We recommend management design and implement an internal control around review of HRSA guidance and the subsequent submissions in order to ensure proper review of all elements of the relevant guidance prior to submission to the portal. Additionally, we recommend the Hospital contact HRSA to determine any required corrective actions related to the incorrect reporting and correct the error on all future submissions Management?s Views and Corrective Action Plan Management?s response is included in ?Management?s Views and Corrective Action Plan? included at the end of this report.

Categories

Reporting Internal Control / Segregation of Duties

Other Findings in this Audit

Programs in Audit

ALN Program Name Expenditures
97.036 Covid-19 Federal Emergency Management Disaster Relief Public Assistance $42.21M
93.498 Covid-19 Provider Relief Fund and American Rescue Plan (arp) Rural Distribution $6.28M
21.027 Covid-19 Emergency Department Modernization and Renovation $3.00M
93.323 Covid-19 Sars Cov2 Hospital Testing $1.58M
93.461 Covid-19 Hrsa Claims Reimbursement for the Uninsured Program $701,555
93.399 Cancer Control $670,664
21.027 Covid-19 Western Region Plant Modernization $543,631
93.914 Ryan White Part A Hiv Emergency Relief Grant Program 2023 $462,806
93.116 Tuberculosis Ambulatory Care 2022 $144,840
93.940 Dhsts Federal Hiv Prevention Program 2022 $139,907
84.191 Early Intervention Program $135,611
93.914 Ryan White Part A Hiv Emergency Relief Grant Program 2022 $83,719
97.067 Ffy19 Urban Areas Security Initiative (uasi-Local Share) $81,763
20.600 Hts Federal Highway Safety Grant 2022 Morris County Safe Communities $79,499
93.898 New Jersey Cancer Education and Early Detection 2022 $57,584
16.575 Sexual Assault Response Team (sart)/forensic Nurse Examiner (fne) $53,143
93.994 Special Child Health Child Evaluation Centers 2022 $26,235
93.994 Special Child Health Child Evaluation Centers 2023 $25,230
20.600 Hts Federal Highway Safety Grant 2023 Morris County Safe Communities $21,718
93.394 Cancer Detection and Diagnosis Research for Glioblastoma $21,380
93.994 Special Child Health Case Management 2022 $17,949
93.855 Effect of Il-4rar576 Variant on Response to Dupilumab in Children with Asthma (idea) $17,946
93.994 Special Child Health Case Management 2023 $17,675
93.394 M.d. Anderson Edrn-Cvc for Early Detection of Ovarian Cancer (00004221) $16,538
93.898 New Jersey Cancer Education and Early Detection 2023 $11,700
93.991 Preventive Health & Health Services $7,987
93.855 Lyme Meningitis $5,563
16.017 Sexual Assault Services Program $4,483
93.395 Supplemental Per Case Reimbursement: Cog Phi Laurie (ar07544) $2,500
93.865 Sex Differences in Statural Growth Impairment in Pediatric Crohn's Disease $2,325
93.991 Morris Sex Offense Set Aside $2,060
93.837 Clinical, Electrocardiographic & Cardiac Magnetic Resonance Imaging Risk Factors Associated with Ventricular Tachyarrhythmias in Nonischemic Cardiomyopathy Urf (awd00002150) $1,410
93.847 Type 1 Diabetes Trialnet $720