Finding 636112 (2022-002)

Material Weakness
Requirement
ABN
Questioned Costs
-
Year
2022
Accepted
2023-09-28
Audit: 55776
Organization: Advocate Aurora Health, Inc. (IL)

AI Summary

  • Core Issue: The Organization lacked effective internal controls to retain necessary documentation for FEMA expenditures, leading to potential inaccuracies in reported costs.
  • Impacted Requirements: Compliance with Section 200.303 of the Uniform Guidance and retention of records as per Title 2 C.F.R. § 200.333 were not met.
  • Recommended Follow-Up: Implement stronger internal controls to ensure all supporting documentation is retained for FEMA expense reviews and approvals.

Finding Text

Finding 2022-002 Information on the Federal Program: Federal Agency: Department of Homeland Security Assistance Listing No.: 97.036 Disaster Grants ? Public Assistance (Presidentially Declared Disasters) (FEMA) Pass-Through: Illinois State Department of Health Pass-Through Award Number: PA-05-IL-4489-PW-01416(1753) Section III ? Federal Award Findings and Questioned Costs (continued) Pass-Through Award Period of Performance: January 20, 2020 through December 31, 2021 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).? Per the FEMA Project Worksheet Report #664845, under the Subgrant Conditions section, bullet point 1, ?As described in Title 2 Code of Federal Regulations (C.F.R.) ? 200.333, financial records, supporting documents, statistical records and all other non-Federal entity records pertinent to a Federal award must be retained for a period of three (3) years from the date of submission of the final expenditure report or, for Federal awards that are renewed quarterly or annually, from the date of the submission of the quarterly or annual financial report, respectively, as reported to the Federal awarding agency or pass-through entity in the case of a subrecipient.? Condition: The Organization?s internal controls were not suitably designed to retain all supporting documentation over their review and approval of FEMA federal expenditures. Management did not retain supporting documentation to support the inventory usage reports used in the development of the FEMA expenditures. Cause: Management designed a process to accumulate and review expenditures related to the FEMA; however, for certain components of the review and approval the supporting documentation was not retained to evidence that the internal review was sufficiently designed and operating effectively throughout the process. Section III ? Federal Award Findings and Questioned Costs (continued) Management did not retain supporting documentation to support the inventory usage reports used in the development of the FEMA expenditures. Questioned Costs: Unknown Context: The Organization recorded FEMA expenditures on the Schedule based on the number of units of the personal protective equipment (PPE) used during the period of performance outlined in the project worksheet times the average costs of each unit of PPE. The information used to develop the FEMA expenditures was obtained from the Organization?s inventory management system. Management did not retain supporting documentation to support the reliance on the inventory usage reports; therefore, the information from the inventory management system cannot be relied on for Uniform Guidance purposes. Management represented that they performed a review of FEMA expenditures but did not maintain evidence supporting all levels of review and approval of expenses under FEMA. We obtained the Organization?s FEMA project worksheet that reconciled to the schedule of expenditures of federal awards. We then selected a sample of 25 PPE items and agreed the items used and the average unit costs to the inventory management system. In addition, we compared the average unit cost to a third-party invoice to support the unit cost used. Management engaged a third party to perform a physical inventory of supplies at December 31, 2020 which included the PPE claimed in the SEFA obligation. The physical inventory was reconciled to the inventory management system. We selected a sample of inventory counts performed by the third-party agency and agreed the inventory counts back to the third-party records, noting no exceptions. A physical inventory was not performed at December 31, 2021. Total federal expenditures for Assistance Listing 97.036 recorded on the Schedule totaled $35,508,438 for the year ended December 31, 2022. Section III ? Federal Award Findings and Questioned Costs (continued) Effect or Potential Effect: The amounts submitted for reimbursement and the reports submitted could be inaccurate or incomplete. Identification as a Repeat Finding, if Applicable: This is not a repeat finding. Recommendation: The Organization should design and implement internal controls that are sufficiently precise and require supporting documentation be retained over the review and approval of FEMA expenses. The Organization should retain evidence of internal controls related to access and change management over the report or a quality review process over the inventory reports. Management response: The FEMA personal protective equipment (PPE) claim covered two years, which are 2020 and 2021. As noted in the audit, the Organization engaged a third party to perform a physical inventory of supplies at December 31, 2020 which included the PPE claimed in the SEFA obligation. The physical inventory was reconciled to the inventory management system. The audit selected a sample inventory count performed by third party and agreed the inventory counts back to the third party records noting no exceptions. A physical inventory was not performed at December 31, 2021. Due to the COVID pandemic, there were unusual circumstances that precluded an annual physical inventory in 2021, due to the easy transmission of COVID-19, by breathing in air carrying droplets or aerosol particles that contain the SARS-CoV-2 virus when close to an infected person or in poorly ventilated spaces with infected persons. Noting there were no system changes to the inventory system during 2021, we relied on the prior year audits and internal control review of the inventory system to provide comfort for the Organization for reliance on the inventory usage for this FEMA claim. In addition to relying on past inventory documented audit controls, the Organization routinely reviews the supply expense generated from the inventory system.

Categories

Equipment & Real Property Management Subrecipient Monitoring Reporting

Other Findings in this Audit

  • 59655 2022-001
    Material Weakness
  • 59656 2022-001
    Material Weakness Repeat
  • 59657 2022-001
    Material Weakness Repeat
  • 59658 2022-001
    Material Weakness Repeat
  • 59659 2022-001
    Material Weakness Repeat
  • 59660 2022-001
    Material Weakness Repeat
  • 59661 2022-001
    Material Weakness Repeat
  • 59662 2022-001
    Material Weakness Repeat
  • 59663 2022-001
    Material Weakness Repeat
  • 59664 2022-001
    Material Weakness Repeat
  • 59665 2022-001
    Material Weakness Repeat
  • 59666 2022-001
    Material Weakness Repeat
  • 59667 2022-001
    Material Weakness Repeat
  • 59668 2022-001
    Material Weakness Repeat
  • 59669 2022-001
    Material Weakness Repeat
  • 59670 2022-002
    Material Weakness
  • 59671 2022-001
    Material Weakness Repeat
  • 59672 2022-001
    Material Weakness Repeat
  • 59673 2022-001
    Material Weakness Repeat
  • 59674 2022-001
    Material Weakness Repeat
  • 59675 2022-001
    Material Weakness Repeat
  • 59676 2022-001
    Material Weakness Repeat
  • 59677 2022-001
    Material Weakness Repeat
  • 59678 2022-001
    Material Weakness Repeat
  • 59679 2022-001
    Material Weakness Repeat
  • 59680 2022-001
    Material Weakness Repeat
  • 636097 2022-001
    Material Weakness
  • 636098 2022-001
    Material Weakness Repeat
  • 636099 2022-001
    Material Weakness Repeat
  • 636100 2022-001
    Material Weakness Repeat
  • 636101 2022-001
    Material Weakness Repeat
  • 636102 2022-001
    Material Weakness Repeat
  • 636103 2022-001
    Material Weakness Repeat
  • 636104 2022-001
    Material Weakness Repeat
  • 636105 2022-001
    Material Weakness Repeat
  • 636106 2022-001
    Material Weakness Repeat
  • 636107 2022-001
    Material Weakness Repeat
  • 636108 2022-001
    Material Weakness Repeat
  • 636109 2022-001
    Material Weakness Repeat
  • 636110 2022-001
    Material Weakness Repeat
  • 636111 2022-001
    Material Weakness Repeat
  • 636113 2022-001
    Material Weakness Repeat
  • 636114 2022-001
    Material Weakness Repeat
  • 636115 2022-001
    Material Weakness Repeat
  • 636116 2022-001
    Material Weakness Repeat
  • 636117 2022-001
    Material Weakness Repeat
  • 636118 2022-001
    Material Weakness Repeat
  • 636119 2022-001
    Material Weakness Repeat
  • 636120 2022-001
    Material Weakness Repeat
  • 636121 2022-001
    Material Weakness Repeat
  • 636122 2022-001
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $35.51M
93.498 Covid-19 Provider Relief Fund and American Rescue Plan (arp) Rural Distribution $34.35M
93.788 Opioid Str $747,335
10.557 Special Supplemental Nutrition Program for Women, Infants, and Children $588,032
21.027 Coronavirus State and Local Fiscal Recovery Funds $377,602
93.959 Block Grants for Prevention and Treatment of Substance Abuse $285,068
93.889 National Bioterrorism Hospital Preparedness Program $241,700
93.866 Aging Research $198,004
93.436 Well-Integrated Screening and Evaluation for Women Across the Nation (wisewoman) $166,501
16.575 Crime Victim Assistance $159,830
93.958 Block Grants for Community Mental Health Services $133,506
93.307 Minority Health and Health Disparities Research $122,925
93.421 Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nations Health $94,000
93.242 Mental Health Research Grants $89,204
93.399 Cancer Control $52,007
93.136 Injury Prevention and Control Research and State and Community Based Programs $40,694
93.865 Child Health and Human Development Extramural Research $34,897
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $30,360
93.074 Hospital Preparedness Program (hpp) and Public Health Emergency Preparedness (phep) Aligned Cooperative Agreements $26,925
93.279 Drug Abuse and Addiction Research Programs $22,704
93.393 Cancer Cause and Prevention Research $19,059
20.600 State and Community Highway Safety $17,539
93.566 Refugee and Entrant Assistance_state Administered Programs $16,062
16.754 Harold Rogers Prescription Drug Monitoring Program $9,151
93.226 Research on Healthcare Costs, Quality and Outcomes $8,776
93.497 Family Violence Prevention and Services/ Sexual Assault/rape Crisis Services and Supports $8,191
93.086 Healthy Marriage Promotion and Responsible Fatherhood Grants $6,616
93.837 Cardiovascular Diseases Research $5,700
10.555 National School Lunch Program $5,562
10.558 Child and Adult Care Food Program $1,272
93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders $479