Finding Text
Finding 2022-002 Reporting Information on the federal program: Federal Grantor: United States Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) Assistance Listing No.: 93.498, COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Provider Relief Fund Reporting Entities: Mercy Hospital Fort Smith, Mercy Hospital Springfield, Mercy Hospital Oklahoma City, Mercy Hospital Joplin Tax Identification Numbers: 710240352, 440552485, 730579285, 270814858 Period of Availability: 01/01/2020?12/31/2021 (Period 2) and 01/01/2020?06/30/2022 (Period 3) 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).? 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 the 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 amounts reported for net patient service revenue (NPSR) by payer for calendar year 2021 Quarter 4 (CY2021 Q4) were incorrect. However, total NPSR was correct. Cause: Management?s review of the allocation of total NPSR to the payer classification required in the PRF report was not sufficiently precise to detect that the incorrect quarter?s payer percentages were used to allocate gross revenue for CY2021 Q4. Effect or potential effect: NPSR by payer was incorrectly reported for CY2021 Q4. Questioned costs: None. Context: We tested 5 of 14 Period 2 and 3 PRF Reports submitted to HRSA. For 4 of the 5 Period 2 and 3 PRF reports tested, the NPSR amounts reported by payer were incorrect for CY2021 Q4 as follows (increase/(decrease)): See chart/table in the Schedule of Findings and Questioned Costs. The differences noted by payer resulting from the use of incorrect allocation percentages did not impact total NPSR reported for CY2021 Q4. Total federal expenditures for Assistance Listing 93.498 totaled $81,685,379 for the year ended June 30, 2022. Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. Recommendation: Mercy Health should ensure internal controls over the review of PRF Reports are enhanced to include sufficient precision to allow for accurate reporting of NPSR by payer. Views of Responsible Officials: While there was no impact on total NPSR reported for Q4 2021, we agree that the percentages used to allocate gross revenue by payer were incorrect. Going forward, we will provide additional review of payer allocation percentages to ensure accuracy.