MAIMONIDES MEDICAL CENTERNon-Profit

2022-001 – Reporting of Provider Relief Fund (“PRF”) Lost Revenues Cluster: Not applicable Federal Granting Agency: Health Resources and Services Administration Award Name: COVID-19 - Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing #: 93.498 Assistance Listing Title: COVID-19 - Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution – Period 4 Award Year: January 1, 2020 – December 31, 2022 Criteria - Step Eight of the Steps for Reporting on Use of Funds section of the October 27, 2022 Provider Relief Fund Distributions and American Rescue Plan Rural Distribution Post-Payment Notice of Reporting Requirements requires recipients to report PRF payment amounts received not fully expended on health care-related expenses attributable to COVID-19 may be applied to patient care lost revenues up to the end of the quarter in which the Public Health Emergency ends. Recipients may choose to apply PRF payments toward lost revenues using either of three options up to the amount: (i)of the difference between actual patient care revenues; (ii) of the difference between budgeted (approved prior to March 27, 2020) and actual patient care revenues; or (iii) calculated by any reasonable method of estimating revenues. Condition - In the Period 4 submission of Maimonides Midwood Medical Center (a consolidated subsidiary of the Medical Center), the Period 4 PRF funding amount of $471,535 was correctly included in the Payments to Recipient section but was incorrectly included in the Q1 2022 Estimated Lost Revenues amount as Q1 lost revenues. Cause - The HRSA PRF Reporting instructions were not interpreted correctly, resulting in an error in reporting the Period 4 PRF funding amount received incorrectly as Q1 2022 Estimated Lost Revenues in the Maimonides Midwood Community Hospital Period 4 submission. Effect - Reporting the Period 4 PRF funding amount received as Q1 2022 lost revenues resulted in an incorrect calculation of the Cumulative Lost Revenues Total in the Maimonides Midwood Community Hospital Period 4 submission. The Cumulative Lost Revenues Total in the Period 4 submission of $30,476,952 should have been $30,005,417. Additionally, total unused lost revenues available for future reporting periods of $13,719,407, should have been $13,247,872. Questioned Costs - None noted as this relates to the amount of lost revenues reported and Maimonides Midwood Community Hospital had allowable unused lost revenues exceeding the total PRF funding amount received. Recommendation - We recommended the Medical Center to contact the Health Resources & Services Administrator (HRSA) to determine any required corrective actions related to the incorrect reporting. We also recommend that the Medical Center ensure that future PRF submissions follow the HRSA PRF reporting instructions. Management’s Views and Corrective Action Plan - Management's views and corrective action plan is included at the end of this report after the summary schedule of prior audit findings and status.

2022-001 – Reporting of Provider Relief Fund (“PRF”) Lost Revenues Cluster: Not applicable Federal Granting Agency: Health Resources and Services Administration Award Name: COVID-19 - Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing #: 93.498 Assistance Listing Title: COVID-19 - Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution – Period 4 Award Year: January 1, 2020 – December 31, 2022 Criteria - Step Eight of the Steps for Reporting on Use of Funds section of the October 27, 2022 Provider Relief Fund Distributions and American Rescue Plan Rural Distribution Post-Payment Notice of Reporting Requirements requires recipients to report PRF payment amounts received not fully expended on health care-related expenses attributable to COVID-19 may be applied to patient care lost revenues up to the end of the quarter in which the Public Health Emergency ends. Recipients may choose to apply PRF payments toward lost revenues using either of three options up to the amount: (i)of the difference between actual patient care revenues; (ii) of the difference between budgeted (approved prior to March 27, 2020) and actual patient care revenues; or (iii) calculated by any reasonable method of estimating revenues. Condition - In the Period 4 submission of Maimonides Midwood Medical Center (a consolidated subsidiary of the Medical Center), the Period 4 PRF funding amount of $471,535 was correctly included in the Payments to Recipient section but was incorrectly included in the Q1 2022 Estimated Lost Revenues amount as Q1 lost revenues. Cause - The HRSA PRF Reporting instructions were not interpreted correctly, resulting in an error in reporting the Period 4 PRF funding amount received incorrectly as Q1 2022 Estimated Lost Revenues in the Maimonides Midwood Community Hospital Period 4 submission. Effect - Reporting the Period 4 PRF funding amount received as Q1 2022 lost revenues resulted in an incorrect calculation of the Cumulative Lost Revenues Total in the Maimonides Midwood Community Hospital Period 4 submission. The Cumulative Lost Revenues Total in the Period 4 submission of $30,476,952 should have been $30,005,417. Additionally, total unused lost revenues available for future reporting periods of $13,719,407, should have been $13,247,872. Questioned Costs - None noted as this relates to the amount of lost revenues reported and Maimonides Midwood Community Hospital had allowable unused lost revenues exceeding the total PRF funding amount received. Recommendation - We recommended the Medical Center to contact the Health Resources & Services Administrator (HRSA) to determine any required corrective actions related to the incorrect reporting. We also recommend that the Medical Center ensure that future PRF submissions follow the HRSA PRF reporting instructions. Management’s Views and Corrective Action Plan - Management's views and corrective action plan is included at the end of this report after the summary schedule of prior audit findings and status.

2022-002 – Completeness and accuracy of the Schedule of Expenditures of Federal Awards- Significant Deficiency Cluster: Not applicable Federal Granting Agency: Department of Homeland Security and Emergency Services Award Name: COVID-19 – Disaster Grants- Public Assistance (Presidentially Declared Disasters) Pass-Through from New York State Department of Homeland Security and Emergency Services Assistance Listing #: 97.036 Assistance Listing Title: COVID-19 - Disaster Grants- Public Assistance (Presidentially Declared Disasters) Pass-Through from New York State Department of Homeland Security and Emergency Services Award Year: January 1, 2022- December 31, 2022 Criteria 2 CFR 200.510 Financial statements requires auditees to prepare a schedule of expenditures of Federal awards for the period covered by the auditee's financial statements which must include the total Federal awards expended as determined in accordance with 2 CFR 200.502. The information presented should be consistent with the accounting records and other federal guidance. Condition FEMA funds obligated in 2022 for eligible expenditures expended in prior periods totaling $33,715,590 were excluded from the 2022 consolidated financial statements and Statement of Expenditures of Federal Awards (“SEFA”). Management has revised the consolidated financial statements as of and for the year ended December 31, 2022 and included this amount in the SEFA for the year ended December 31, 2022 (Refer to Note 1 and Note 10 in the accompanying consolidated financial statements and Note 2 and Note 7 in the accompanying SEFA). This error did not impact the major program selection for testing in 2022. Cause The status of the review and approval process by FEMA and New York State Department of Homeland Security and Emergency Services and requirement to record FEMA funds in the consolidated financial statements and SEFA when obligated by FEMA was not interpreted correctly by management. Effect A SEFA that is not complete and accurate could impact the scoping of an entity’s major programs and result in incomplete information being provided to the federal government. Questioned Costs None noted. Recommendation We recommend the Medical Center perform a reconciliation of FEMA project applications reported in the FEMA portal to the consolidated financial statements and SEFA to ensure all FEMA project funds obligated and expended are reported in the proper period. Management’s Views and Corrective Action Plan Management's views and corrective action plan is included at the end of this report after the summary schedule of prior audit findings and status.

2022-001 – Reporting of Provider Relief Fund (“PRF”) Lost Revenues Cluster: Not applicable Federal Granting Agency: Health Resources and Services Administration Award Name: COVID-19 - Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing #: 93.498 Assistance Listing Title: COVID-19 - Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution – Period 4 Award Year: January 1, 2020 – December 31, 2022 Criteria - Step Eight of the Steps for Reporting on Use of Funds section of the October 27, 2022 Provider Relief Fund Distributions and American Rescue Plan Rural Distribution Post-Payment Notice of Reporting Requirements requires recipients to report PRF payment amounts received not fully expended on health care-related expenses attributable to COVID-19 may be applied to patient care lost revenues up to the end of the quarter in which the Public Health Emergency ends. Recipients may choose to apply PRF payments toward lost revenues using either of three options up to the amount: (i)of the difference between actual patient care revenues; (ii) of the difference between budgeted (approved prior to March 27, 2020) and actual patient care revenues; or (iii) calculated by any reasonable method of estimating revenues. Condition - In the Period 4 submission of Maimonides Midwood Medical Center (a consolidated subsidiary of the Medical Center), the Period 4 PRF funding amount of $471,535 was correctly included in the Payments to Recipient section but was incorrectly included in the Q1 2022 Estimated Lost Revenues amount as Q1 lost revenues. Cause - The HRSA PRF Reporting instructions were not interpreted correctly, resulting in an error in reporting the Period 4 PRF funding amount received incorrectly as Q1 2022 Estimated Lost Revenues in the Maimonides Midwood Community Hospital Period 4 submission. Effect - Reporting the Period 4 PRF funding amount received as Q1 2022 lost revenues resulted in an incorrect calculation of the Cumulative Lost Revenues Total in the Maimonides Midwood Community Hospital Period 4 submission. The Cumulative Lost Revenues Total in the Period 4 submission of $30,476,952 should have been $30,005,417. Additionally, total unused lost revenues available for future reporting periods of $13,719,407, should have been $13,247,872. Questioned Costs - None noted as this relates to the amount of lost revenues reported and Maimonides Midwood Community Hospital had allowable unused lost revenues exceeding the total PRF funding amount received. Recommendation - We recommended the Medical Center to contact the Health Resources & Services Administrator (HRSA) to determine any required corrective actions related to the incorrect reporting. We also recommend that the Medical Center ensure that future PRF submissions follow the HRSA PRF reporting instructions. Management’s Views and Corrective Action Plan - Management's views and corrective action plan is included at the end of this report after the summary schedule of prior audit findings and status.

2022-001 – Reporting of Provider Relief Fund (“PRF”) Lost Revenues Cluster: Not applicable Federal Granting Agency: Health Resources and Services Administration Award Name: COVID-19 - Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing #: 93.498 Assistance Listing Title: COVID-19 - Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution – Period 4 Award Year: January 1, 2020 – December 31, 2022 Criteria - Step Eight of the Steps for Reporting on Use of Funds section of the October 27, 2022 Provider Relief Fund Distributions and American Rescue Plan Rural Distribution Post-Payment Notice of Reporting Requirements requires recipients to report PRF payment amounts received not fully expended on health care-related expenses attributable to COVID-19 may be applied to patient care lost revenues up to the end of the quarter in which the Public Health Emergency ends. Recipients may choose to apply PRF payments toward lost revenues using either of three options up to the amount: (i)of the difference between actual patient care revenues; (ii) of the difference between budgeted (approved prior to March 27, 2020) and actual patient care revenues; or (iii) calculated by any reasonable method of estimating revenues. Condition - In the Period 4 submission of Maimonides Midwood Medical Center (a consolidated subsidiary of the Medical Center), the Period 4 PRF funding amount of $471,535 was correctly included in the Payments to Recipient section but was incorrectly included in the Q1 2022 Estimated Lost Revenues amount as Q1 lost revenues. Cause - The HRSA PRF Reporting instructions were not interpreted correctly, resulting in an error in reporting the Period 4 PRF funding amount received incorrectly as Q1 2022 Estimated Lost Revenues in the Maimonides Midwood Community Hospital Period 4 submission. Effect - Reporting the Period 4 PRF funding amount received as Q1 2022 lost revenues resulted in an incorrect calculation of the Cumulative Lost Revenues Total in the Maimonides Midwood Community Hospital Period 4 submission. The Cumulative Lost Revenues Total in the Period 4 submission of $30,476,952 should have been $30,005,417. Additionally, total unused lost revenues available for future reporting periods of $13,719,407, should have been $13,247,872. Questioned Costs - None noted as this relates to the amount of lost revenues reported and Maimonides Midwood Community Hospital had allowable unused lost revenues exceeding the total PRF funding amount received. Recommendation - We recommended the Medical Center to contact the Health Resources & Services Administrator (HRSA) to determine any required corrective actions related to the incorrect reporting. We also recommend that the Medical Center ensure that future PRF submissions follow the HRSA PRF reporting instructions. Management’s Views and Corrective Action Plan - Management's views and corrective action plan is included at the end of this report after the summary schedule of prior audit findings and status.

2022-002 – Completeness and accuracy of the Schedule of Expenditures of Federal Awards- Significant Deficiency Cluster: Not applicable Federal Granting Agency: Department of Homeland Security and Emergency Services Award Name: COVID-19 – Disaster Grants- Public Assistance (Presidentially Declared Disasters) Pass-Through from New York State Department of Homeland Security and Emergency Services Assistance Listing #: 97.036 Assistance Listing Title: COVID-19 - Disaster Grants- Public Assistance (Presidentially Declared Disasters) Pass-Through from New York State Department of Homeland Security and Emergency Services Award Year: January 1, 2022- December 31, 2022 Criteria 2 CFR 200.510 Financial statements requires auditees to prepare a schedule of expenditures of Federal awards for the period covered by the auditee's financial statements which must include the total Federal awards expended as determined in accordance with 2 CFR 200.502. The information presented should be consistent with the accounting records and other federal guidance. Condition FEMA funds obligated in 2022 for eligible expenditures expended in prior periods totaling $33,715,590 were excluded from the 2022 consolidated financial statements and Statement of Expenditures of Federal Awards (“SEFA”). Management has revised the consolidated financial statements as of and for the year ended December 31, 2022 and included this amount in the SEFA for the year ended December 31, 2022 (Refer to Note 1 and Note 10 in the accompanying consolidated financial statements and Note 2 and Note 7 in the accompanying SEFA). This error did not impact the major program selection for testing in 2022. Cause The status of the review and approval process by FEMA and New York State Department of Homeland Security and Emergency Services and requirement to record FEMA funds in the consolidated financial statements and SEFA when obligated by FEMA was not interpreted correctly by management. Effect A SEFA that is not complete and accurate could impact the scoping of an entity’s major programs and result in incomplete information being provided to the federal government. Questioned Costs None noted. Recommendation We recommend the Medical Center perform a reconciliation of FEMA project applications reported in the FEMA portal to the consolidated financial statements and SEFA to ensure all FEMA project funds obligated and expended are reported in the proper period. Management’s Views and Corrective Action Plan Management's views and corrective action plan is included at the end of this report after the summary schedule of prior audit findings and status.

2021-003 ? Potential costs to be submitted from other sources included in HRSA reporting portal submissions Cluster: Not applicable Program: COVID-19 - Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing Number: 93.498 Agency: Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Award Year: 1/1/2020-6/30/2021 Award Number: Not available Criteria: In accordance with the Health Resources and Services Administration (HRSA) Provider Relief Fund Terms and Conditions, eligible providers may use Provider Relief Funds to prevent, prepare for, and respond to coronavirus, and for related expenses or lost revenues attributable to coronavirus. Condition: Within its PRF ? Reporting Period 1 and Period 2 reports submitted in the HRSA portal, the Medical Center reported Total Other PRF Expenses inclusive of a potential amount submitted or planned to be submitted under FEMA, that may or may not be approved by FEMA. The amount included in the PRF portal submissions was $8.6M, with $3.5M and $5.1M submitted in the Period 1 and Period 2 portal submissions, respectively. Cause: Since a significant amount of expenses attributable to coronavirus are still pending submission to FEMA or are undergoing FEMA eligibility review, the Medical Center had planned to perform a final reconciliation of expenses during Period 4 PRF Reporting. Effect: The result of the condition caused certain expenses to be reported within the Medical Center?s PRF ? Reporting Period 1 and Period 2 submissions, which may be reimbursed from other sources if not denied by FEMA. Questioned Costs: There are no questioned costs associated with the finding. While the Medical Center?s submission to HRSA included $8.6M which may be reimbursed from other sources, the amount of lost revenues reported could have covered this amount, such that this finding does not impact the total Provider Relief Program expenses recorded within the SEFA. Recommendation: We recommend the Medical Center to adjust the expenses reported in the PRF ? Reporting Period 1 and Period 2 report submissions to HRSA to exclude these amounts which may be reimbursed from other sources. Management?s Views and Corrective Action Plan: Refer to Management?s Views and Corrective Action Plan at the end of the report.

2021-004 ? Expenses incurred prior to January 1, 2020 Cluster: Not applicable Program: COVID-19 - Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing Number: 93.498 Agency: Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Award Year: 1/1/2020-6/30/2021 Award Number: Not available Criteria: In accordance with the Health Resources and Services Administration (HRSA) Provider Relief Fund Terms and Conditions, eligible providers may use Provider Relief Funds (PRF) to prevent, prepare for, and respond to coronavirus, and for related expenses or lost revenues attributable to coronavirus. Condition: Within its PRF ? Reporting Period 1 report submitted in the HRSA portal, the Medical Center reported Total Other PRF Expenses inclusive of an expense of $5,135 related to outsourced healthcare staffing support which was billed on 1/3/2020 but for the pay period ending 12/27/2019. As a result, the invoice selected was outside of the allowable period. To assess any additional exposure, we looked to the detail of all expenses related to this service provider, and included in the Period 1 portal submission, noting $81,327 related to the period preliminary to or on the day of contract signing. We note that this service provider was already engaged and being utilized by the Medical Center, but it was not until March 14, 2020 that an additional contract was signed specifically related to COVID. Concerning the period preliminary to the signing of the COVID contract, we were unable to obtain evidence that this work related to COVID. As a result, we consider the total exposure to be services reported on or before March 14, 2020, the period prior to the COVID contract being signed. Cause: The initial expense of $5,135 identified through our compliance testing was captured in the Medical Center?s PRF ? Reporting Period 1 report due to the fact the Medical Center was billed on 1/3/2020, and thus this expense was reported as a Q1 2020 expense. Effect: The result of the condition caused this initial expense, which was outside of the time period allowed, to be reported within the Medical Center?s PRF ? Reporting Period 1 submission (i.e., PRF recipients may use payments for eligible expenses incurred prior to receipt of those payments (i.e., pre-award costs) dating back to January 1, 2020, so long as they are to prevent, prepare for, and respond to coronavirus.). In total, $81,327 in expenses were reported relating to this service provider for which we were unable to obtain evidence that the work was COVID related. Questioned Costs: There are no questioned costs associated with the finding. While the Medical Center?s submission to HRSA included $81,327 in unallowable expenses, the amount of lost revenues reported could have covered this amount, such that this finding does not impact the total PRF expenses recorded within the SEFA. Recommendation: We recommend the Medical Center to adjust the expenses reported in the PRF ? Reporting Period 1 report submission to HRSA to exclude these amounts. Management?s Views and Corrective Action Plan: Refer to Management?s Views and Corrective Action Plan at the end of the report.

2021-005 ? Duplicates payments not returned to HRSA Cluster: Not applicable Program: COVID-19 - HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Assistance Listing Number: 93.461 Agency: Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Award Year: 1/1/2021-12/31/2021 Award Number: Not available Criteria: HRSA COVID-19 Uninsured Program requires health care providers to ensure that a patient is uninsured (that is has no medical coverage through an individual, employer-sponsored plan, a federal healthcare program, or the Federal Employees Health Benefits Program at the time services were rendered, and no other payer will reimburse the health care provide for COVID-19 vaccination, testing and/or care for that patient) and therefore eligible for reimbursement from this program. Condition: Of the 40 claims selected, we identified 4 claims where duplicate payments in the aggregate amount of $161,461 were received from HRSA. These situations resulted from a project that was performed by Management when payments were not forthcoming in a timely manner. Due to the fact that a HRSA ID was only valid for 30 days, in an attempt to obtain payment, Management created a different HRSA ID for certain claims, and resubmitted previously billed invoices under these new HRSA ID numbers. As a result of the instances identified in our testing sample, Management performed an analysis of all claims with a credit balance. In total, 8 claims were found to have duplicate payments, resulting in an aggregate amount of $283,040 which is required to be returned to HRSA. Although these duplicate payments were appropriately identified by Management, there is no evidence of follow up action to date by the Medical Center in order to return these payments. We deem this to be a finding due to untimely monitoring as certain of these duplicate payments were received over a year ago. Cause: These duplicate payments resulted from resubmitted claims related to previously billed invoices, where an additional HRSA ID number was generated by the Medical Center. Effect: The result of the condition caused duplicate payments to be received from HRSA for individual claims, paid out on separate HRSA ID numbers. Questioned Costs: The amount of questioned costs associated with the finding amounts to $283,040. Recommendation: We recommend the Medical Center to return these duplicate payments to HRSA as soon as possible. Management?s Views and Corrective Action Plan: Refer to Management?s Views and Corrective Action Plan at the end of the report.