Finding Text
Identification of the federal program: Federal Grantor: U.S. Department of Health and Human Services Assistance Listing No.: 93.498 COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Award Period of Performance: January 1, 2020 ? December 31, 2022 Criteria or Specific Requirement (including statutory, regulatory or other citation): Section 200.303 of the Uniform Guidance states the following regarding internal control: ?The non-Federal entity must: (a) 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. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO).? Condition: Per discussion with management, San Antonio Regional Hospital (the Hospital) has processes and internal controls in place to ensure lost revenues submitted in the Health Resources and Services Administration (HRSA) Portal were allowable under the terms and conditions of the award. These internal controls include ensuring the completeness and accuracy of the lost revenue calculation. However, management did not consistently retain documentation to evidence the performance of these controls. Cause: Management did not retain documentation evidencing the performance of this control. Effect or potential effect: The Hospital did not consistently retain documentation to evidence the performance of internal controls over the lost revenue calculation submitted to HRSA, which could lead to noncompliance. Questioned Costs: None. Context: During our testing over the PRF program, we observed that management did not retain evidence of controls surrounding the lost revenue calculation during January 1, 2020 ? December 31, 2022. Total federal expenditures for Assistance Listing No. 93.498 totaled $1,360,603 for the year ended December 31, 2022. Identification as a repeat finding, if applicable: The finding is a repeat finding of 2021-001. Recommendation: The Hospital should refine its process and retain documentation to evidence management?s review of the lost revenue calculation submitted to HRSA. View of Responsible Officials: The Hospital agrees with the finding and will implement procedures to ensure control documentation is retained.