Finding 628491 (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.

Categories

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

Other Findings in this Audit

  • 52049 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