EIN: 362170833
UEI: XJ7MMPHBMGM7
Data as of August 21, 2026
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on May 10, 2024. Under 2 CFR 200.521(d), a pass-through entity that provided federal funds to this organization for this audit period must issue a management decision on these findings by November 10, 2024 (650 days ago).
What is a management decision? →In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.
Show full finding ▾Hide full finding ▴Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.
Finding 2023‐002 – Reporting Requirements Grantor: U.S. Department of Health and Human Services Program: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing #: 93.498 Title: COVID-19 Provider Relief Fund Award Year: Fiscal year 2023 9/1/22-8/31/23 Award Number: Not Listed Management understands the importance of accurate reporting for the Provider Relief Fund reporting. At the time of the second and third reporting submissions,the proper review and tie out of final net revenue was not completed for August 2021 net revenue. Corrective Action Plan and Anticipated Completion Date: The net revenue amounts reported in error for August 2021 will be revised from the reported estimated amounts in subsequent filings, if required by HRSA. With no lost revenue being claimed beyond what has already been reported to HRSA, management will also update methodology narrative to reference the last month with lost revenues was March 2021 and no additional revenue will be reported.
2022-001
In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.
Show full finding ▾Hide full finding ▴Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. -Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center understated actual revenues by $1,095,540 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the month of August 2021 in error. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None. Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two reporting entities. Recommendation: We recommend that management’s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in lost revenue calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.
Finding 2023‐002 – Reporting Requirements Grantor: U.S. Department of Health and Human Services Program: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing #: 93.498 Title: COVID-19 Provider Relief Fund Award Year: Fiscal year 2023 9/1/22-8/31/23 Award Number: Not Listed Management understands the importance of accurate reporting for the Provider Relief Fund reporting. At the time of the second and third reporting submissions,the proper review and tie out of final net revenue was not completed for August 2021 net revenue. Corrective Action Plan and Anticipated Completion Date: The net revenue amounts reported in error for August 2021 will be revised from the reported estimated amounts in subsequent filings, if required by HRSA. With no lost revenue being claimed beyond what has already been reported to HRSA, management will also update methodology narrative to reference the last month with lost revenues was March 2021 and no additional revenue will be reported.
2022-001
In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.
Show full finding ▾Hide full finding ▴Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.
Finding 2023‐003 – Reporting Requirements Grantor: U.S. Department of Health and Human Services Program: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing #: 93.498 Title: COVID-19 Provider Relief Fund Award Year: Fiscal year 2023 9/1/22-8/31/23 Award Number: Not Listed Management understands the importance of accurate reporting for the Provider Relief Fund reporting. At the time of Period 5 reporting, one entity included expenses that were previously reported in Period 2 reporting. Corrective Action Plan and Anticipated Completion Date: The total expenses reported in error for Period 5 will be revised in subsequent filings, if required by HRSA. With the correction of the error, total expenses to be used in subsequent filings still exceed payments received. On a going forward basis, Management’s review will include a reconciliation of expenses reported on the current Period submission to ensure it excludes expenses claimed in prior Period.
In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.
Show full finding ▾Hide full finding ▴Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to allowable cost and reporting requirements for this program, including: -Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity, the Medical Center reported other PRF expenses of $855,130. These same expenses had previously been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been reported again in Period 5. Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of likely questioned costs is the same as the known questioned costs of $855,130. Cause: In preparing the Period 5 reports, management included in error PRF expenses that had previously been reported in Period 2. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the error before submission. Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by this error. Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period 5. Repeat finding: No. Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting portal include review of documentation supporting all reported PRF expenses for the period and a review and reconciliation of the PRF expenses previously reported in prior periods. Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s recommendation.
Finding 2023‐003 – Reporting Requirements Grantor: U.S. Department of Health and Human Services Program: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing #: 93.498 Title: COVID-19 Provider Relief Fund Award Year: Fiscal year 2023 9/1/22-8/31/23 Award Number: Not Listed Management understands the importance of accurate reporting for the Provider Relief Fund reporting. At the time of Period 5 reporting, one entity included expenses that were previously reported in Period 2 reporting. Corrective Action Plan and Anticipated Completion Date: The total expenses reported in error for Period 5 will be revised in subsequent filings, if required by HRSA. With the correction of the error, total expenses to be used in subsequent filings still exceed payments received. On a going forward basis, Management’s review will include a reconciliation of expenses reported on the current Period submission to ensure it excludes expenses claimed in prior Period.
The Medical Center's SEFA for the year ended August 31, 2023, which is supplementary information to the Medical Center's financial statements, was restated to include an additional $2,000,000 of federal expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027. Management's processes and internal controls for ensuring that all federal funds expended by the Medical Center are captured and reported in the SEFA were inadquate to detect the omission of the $2,000,000 of federal expenditures. Context: The additional $2,000,000 of federal expenditures increased the total federal expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027 to $2,899,890. This resulted in the reissuance of the single audit report. Cause: The additional federal program expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027, were provided under a separate pass-through grant and were inadvertently omitted from the SEFA due to an oversight in the preparation of the SEFA resulting in part from and coinciding with the turnover of key personnel involved with and having oversight over the $2,000,000 award. Effect: Improper reporting of federal expenditures can result in material errors on the SEFA leading to inaccurate major program determination. In this instance an error did result in the identification of an additional major program. Repeat finding: No. Recommendation: We recommend that management enhance its process and internal controls around the timely identification of federal awards and preparation of the SEFA to ensure completeness and accuracy of the SEFA. Views of responsible officials of the auditee: Management agrees with the finding and the auditor's recommendation.
Show full finding ▾Hide full finding ▴Federal program: U.S. Department of the Treasury; Passed-through Illinois Department of Public Health-ALN 21.027, COVID-19 Coronavirus State and Local Fiscal Recovery Funds. Criteria: In accordance with 2 CFR 200 200.510(b), the auditee must prepare a Schedule of Expenditures of Federal Awards (SEFA) 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. Condition: The Medical Center's SEFA for the year ended August 31, 2023, which is supplementary information to the Medical Center's financial statements, was restated to include an additional $2,000,000 of federal expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027. Management's processes and internal controls for ensuring that all federal funds expended by the Medical Center are captured and reported in the SEFA were inadquate to detect the omission of the $2,000,000 of federal expenditures. Context: The additional $2,000,000 of federal expenditures increased the total federal expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027 to $2,899,890. This resulted in the reissuance of the single audit report. Cause: The additional federal program expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027, were provided under a separate pass-through grant and were inadvertently omitted from the SEFA due to an oversight in the preparation of the SEFA resulting in part from and coinciding with the turnover of key personnel involved with and having oversight over the $2,000,000 award. Effect: Improper reporting of federal expenditures can result in material errors on the SEFA leading to inaccurate major program determination. In this instance an error did result in the identification of an additional major program. Repeat finding: No. Recommendation: We recommend that management enhance its process and internal controls around the timely identification of federal awards and preparation of the SEFA to ensure completeness and accuracy of the SEFA. Views of responsible officials of the auditee: Management agrees with the finding and the auditor's recommendation.
Finding 2023-004- Lack of Effective Controls Over Preparation of Schedule of Expenditures of Federal Awards Grantor: U.S. Department of the Treasury Assisstance Listing#: 21.027 Title: COVID-19 Coronavirus State and Local Fiscal Recovery Funds Award Year: Fiscal year 2023 9/1/22-8/31/23 Award Number: Not Listed Management understands the importance of effective internal controls over the preparation of the Schedule of Expenditures of Federal Awards (SEFA). At the time of preparing the 2023 SEFA, $2 Million was improperly excluded causing the reported to be restated. Corrective Action Plan and Anticipated Completion Date: The total expenditures reported in error for the 2023 SEFA will be restated and the consolidated Financial and Compliance Report in Accordance with the Uniform Guidance will be re-sibmitted to the appropriate federal and state agencies. On a go forward basis, management's review will include a reconciliation of all grant expenses reported on the current SEFA to the grant awards listed on the State of Illinois Department of Public Health (IDPH) grant portal (EGrMS) to ensure all federal awards are reported.
Federal Program: U.S. Department of the Treasury-ALN 21.027, Coronavirus State and Local Fiscal Recovery Funds. Questioned costs: None. See item 2023-004.
Show full finding ▾Hide full finding ▴Federal Program: U.S. Department of the Treasury-ALN 21.027, Coronavirus State and Local Fiscal Recovery Funds. Questioned costs: None. See item 2023-004.
Finding 2023-005- Improper Preparation of Schedule of Expenditures of Federal Awards Grantor: U.S. Department of the Treasury Assisstance Listing#: 21.027 Title: COVID-19 Coronavirus State and Local Fiscal Recovery Funds Award Year: Fiscal year 2023 9/1/22-8/31/23 Award Number: Not Listed Management understands the importance of effective internal controls over the preparation of the Schedule of Expenditures of Federal Awards (SEFA). At the time of preparing the 2023 SEFA, $2 Million was improperly excluded causing the reported to be restated. Corrective Action Plan and Anticipated Completion Date: The total expenditures reported in error for the 2023 SEFA will be restated and the consolidated Financial and Compliance Report in Accordance with the Uniform Guidance will be re-sibmitted to the appropriate federal and state agencies. On a go forward basis, management's review will include a reconciliation of all grant expenses reported on the current SEFA to the grant awards listed on the State of Illinois Department of Public Health (IDPH) grant portal (EGrMS) to ensure all federal awards are reported.
FAC accepted this audit on March 16, 2023 — management decision was due September 16, 2023.
In the Medical Center?s Period 2 and Period 3 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each affiliated entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-to-actual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for each entity, the Medical Center understated actual revenues by $9,693,882 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year?s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year?s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the reports, management used preliminary estimates of revenue for the month of August 2021 in error. Additionally for one entity, the method used to calculate actual revenue for the month of July 2021 was not consistent with other months. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center?s reporting in the PRF reporting portal for each affiliated entity included an inaccurate amount of actual revenue for the third quarter of calendar year 2021, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None Repeat finding: No Recommendation: We recommend that management correct the error in the Period 4 PRF reporting submissions. We also recommend that management?s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in the calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor?s recommendation.
Show full finding ▾Hide full finding ▴FINDING 2022-001 ? Reporting Requirements Federal program: U.S. Department of Health and Human Services ? ALN 93.498, Provider Relief Fund and American Rescue Plan (`ARP?) Rural Distribution Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (`HHS?) with respect to allowable cost and reporting requirements for this program, including: - Funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. - Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option iii, the alternative method used to calculate lost revenue should be consistent with a narrative description of the methodology as submitted in the PRF reporting portal. Condition: In the Medical Center?s Period 2 and Period 3 reporting in the PRF reporting portal, the Medical Center reported lost revenue using Option iii for each affiliated entity included in the schedule of expenditures of federal awards that received PRF. The alternative method used to calculate lost revenues was budget-to-actual revenues for the period from January 2020 through August 2020 and year-over-year actual revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the third quarter of calendar year 2021 for each entity, the Medical Center understated actual revenues by $9,693,882 in total. Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity, because actual revenue exceeded the prior year?s actual revenue for each entity. Had the correct amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still would have exceeded the prior year?s actual revenue for each entity and no lost revenue would be reported. Cause: In preparing the reports, management used preliminary estimates of revenue for the month of August 2021 in error. Additionally for one entity, the method used to calculate actual revenue for the month of July 2021 was not consistent with other months. Review processes were performed before the reports were submitted, but these reviews did not detect and correct the errors before submission. Effect: The Medical Center?s reporting in the PRF reporting portal for each affiliated entity included an inaccurate amount of actual revenue for the third quarter of calendar year 2021, which was not consistent with methodology described in the Option iii narrative submitted. The PRF reporting correctly reported no lost revenue for the quarter. Questioned costs: None Repeat finding: No Recommendation: We recommend that management correct the error in the Period 4 PRF reporting submissions. We also recommend that management?s review of the lost revenue calculations and reporting in the PRF reporting portal include review of documentation supporting each dollar amount included in the calculation. Views of responsible officials of the auditee: Management agrees with the finding and the auditor?s recommendation.
Management?s View and Corrective Action Plan The following is the Medical Center?s response to the audit of Federal programs in accordance with the Uniform Guidance for the year ended August 31, 2022. Finding 2022-001 ? Reporting Requirements Grantor: U.S. Department of Health and Human Services Program: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance Listing #: 93.498 Title: COVID-19 Provider Relief Fund Award Year: Fiscal year 2022 9/1/21-8/31/22 Award Number: Not Listed Management understands the importance of accurate reporting for the Provider Relief Fund reporting. At the time of the second and third reporting submissions, the proper review and tie out of final net revenue was not completed for August 2021 net revenue. Corrective Action Plan and Anticipated Completion Date: The net revenue amounts reported in error for August 2021 will be revised from the reported estimated amounts to actual net revenues in the Period 4 reporting submission, which will be submitted by March 31, 2023. With no lost revenue being claimed beyond what has already been reported to HRSA, management will also update methodology narrative to reference the last month with lost revenues was March 2021 and no additional revenue will be reported.
FAC accepted this audit on May 11, 2022 — management decision was due November 11, 2022.
Finding 2021-001 ? HRSA Uninsured Patient Eligibility Grantor: Health Resources and Services Administration (?HRSA?) Program: COVID-19 HRSA Claims for the Uninsured Program Assistance Listing #: 93.461 Title: HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Award Year: Fiscal year 2021 9/1/2020 ? 8/31/2021 Award Number: None listed Criteria In accordance with the Coronavirus Aid, Relief, and Economic Security Act and Paycheck Protection Program and Health Care Enhancement Act, HRSA offers reimbursement to providers and facilities for claims covering eligible uninsured individuals. Recipients should ensure that individuals covered by these funds were uninsured at the date of service. In order to provide additional context, background and clarification, the HRSA FAQs note the following: (https://www.hrsa.gov/coviduninsuredclaim/frequently-asked-questions - ?Do health care providers need to determine if an otherwise uninsured individual is Medicaid eligible??), ?Providers must verify and attest that to the best of the provider's knowledge at the time of claim submission, the patient was uninsured at the time the services were provided. For claims for COVID-19 testing and testing-related items and services, treatment of positive cases of COVID-19, and/or vaccine administration, this means that the patient did not have any health care coverage. Providers may submit a claim for uninsured individuals before Medicaid eligibility determination is complete. However, if the provider learns that the individual is retroactively enrolled in Medicaid as of the date of service, the provider must return the payment to HRSA?. Condition In testing compliance with the eligibility requirement, out of 60 claims selected to test patient eligibility, we identified three claims, totaling $300 where management was unable to provide evidence that insurance verification had been performed at the time of service. Two of these three patients were subsequently determined in March 2022, to be insured at the time of service or retroactively enrolled in Medicaid as of the date of service, which qualified the patients as insured at the date of service and therefore ineligible for HRSA reimbursement. Cause Through discussions with management, we understand that the Medical Center did not maintain evidence to support the operating effectiveness of the existing control where the Medical Center ensures the patient is uninsured at the date of service and prior to requesting reimbursement from HRSA. Effect Failure to appropriately identify patient eligibility as uninsured at the time the services were provided could result in inappropriate funds received from HRSA. Questioned Costs $300. Recommendation We recommend the Medical Center enhance its controls and revise its procedures to ensure that all patients are being checked for eligibility through insurance verification at the time of service and prior to submitting a reimbursement claim to HRSA. Management?s Views and Corrective Action Plan Management?s response is included in ?Management?s View and Corrective Action Plan? at the end of this report.
Show full finding ▾Hide full finding ▴Finding 2021-001 ? HRSA Uninsured Patient Eligibility Grantor: Health Resources and Services Administration (?HRSA?) Program: COVID-19 HRSA Claims for the Uninsured Program Assistance Listing #: 93.461 Title: HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Award Year: Fiscal year 2021 9/1/2020 ? 8/31/2021 Award Number: None listed Criteria In accordance with the Coronavirus Aid, Relief, and Economic Security Act and Paycheck Protection Program and Health Care Enhancement Act, HRSA offers reimbursement to providers and facilities for claims covering eligible uninsured individuals. Recipients should ensure that individuals covered by these funds were uninsured at the date of service. In order to provide additional context, background and clarification, the HRSA FAQs note the following: (https://www.hrsa.gov/coviduninsuredclaim/frequently-asked-questions - ?Do health care providers need to determine if an otherwise uninsured individual is Medicaid eligible??), ?Providers must verify and attest that to the best of the provider's knowledge at the time of claim submission, the patient was uninsured at the time the services were provided. For claims for COVID-19 testing and testing-related items and services, treatment of positive cases of COVID-19, and/or vaccine administration, this means that the patient did not have any health care coverage. Providers may submit a claim for uninsured individuals before Medicaid eligibility determination is complete. However, if the provider learns that the individual is retroactively enrolled in Medicaid as of the date of service, the provider must return the payment to HRSA?. Condition In testing compliance with the eligibility requirement, out of 60 claims selected to test patient eligibility, we identified three claims, totaling $300 where management was unable to provide evidence that insurance verification had been performed at the time of service. Two of these three patients were subsequently determined in March 2022, to be insured at the time of service or retroactively enrolled in Medicaid as of the date of service, which qualified the patients as insured at the date of service and therefore ineligible for HRSA reimbursement. Cause Through discussions with management, we understand that the Medical Center did not maintain evidence to support the operating effectiveness of the existing control where the Medical Center ensures the patient is uninsured at the date of service and prior to requesting reimbursement from HRSA. Effect Failure to appropriately identify patient eligibility as uninsured at the time the services were provided could result in inappropriate funds received from HRSA. Questioned Costs $300. Recommendation We recommend the Medical Center enhance its controls and revise its procedures to ensure that all patients are being checked for eligibility through insurance verification at the time of service and prior to submitting a reimbursement claim to HRSA. Management?s Views and Corrective Action Plan Management?s response is included in ?Management?s View and Corrective Action Plan? at the end of this report.
Corrective Action Plan and Anticipate Completion Date Management?s corrective action plan includes: ? Within the patient accounting system, the Registration team will document in the patient notes that an insurance verification was completed, and if no insurance coverage was found, confirm that the patient is indeed uninsured. ? Review of HRSA uninsured claims received - Management completed a Medicaid eligibility check on all patients in which a HRSA uninsured reimbursement for Covid-19 was received. The Medical Center has begun to refund HRSA for these claims and anticipates having all funds returned by May 31, 2022. ? Future HRSA claims ? In addition to the changes within the registration team, Management will also complete a separate Medicaid eligibility verification check on a monthly basis for any patient with a HRSA uninsured payment. For any patients identified as having retroactive Medicaid coverage, a refund will be submitted back to HRSA. This monthly review will begin in May 2022 and continue moving forward.
Finding 2021-002 ? Claim reimbursement for an uninsured patient was not reviewed for backdated Medicaid coverage Grantor: Health Resources and Services Administration (?HRSA?) Program: COVID-19 HRSA Claims for the Uninsured Program Assistance Listing #: 93.461 Title: HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Award Year: Fiscal year 2021 9/1/2020 ? 8/31/2021 Award Number: None listed Criteria In accordance with the Coronavirus Aid, Relief, and Economic Security Act and Paycheck Protection Program and Health Care Enhancement Act, HRSA offers reimbursement to providers and facilities for claims covering eligible uninsured individuals. Recipients should ensure that individuals covered by these funds were uninsured at the date of service. In order to provide additional context, background and clarification, the HRSA FAQs note the following: (https://www.hrsa.gov/coviduninsuredclaim/frequently-asked-questions - ?Do health care providers need to determine if an otherwise uninsured individual is Medicaid eligible??), ?Providers must verify and attest that to the best of the provider's knowledge at the time of claim submission, the patient was uninsured at the time the services were provided. For claims for COVID-19 testing and testing-related items and services, treatment of positive cases of COVID-19, and/or vaccine administration, this means that the patient did not have any health care coverage. Providers may submit a claim for uninsured individuals before Medicaid eligibility determination is complete. However, if the provider learns that the individual is retroactively enrolled in Medicaid as of the date of service, the provider must return the payment to HRSA?. Condition In testing compliance with the eligibility requirement, out of 60 claims selected to test patient eligibility, we identified seven claims, totaling $3,560 where patients were initially uninsured at the time of service, but subsequently became Medicaid eligible and this was not identified by the Medical Center?s processes and controls. It was determined in March and April 2022 that these patients should have been retroactively enrolled in Medicaid as of the date of service, which qualified the patients as insured at the date of service and therefore ineligible for HRSA reimbursement. The chart below outlines the details of each instance identified. Service Date HRSA Reimbursement Amount Date claim submitted to HRSA Reimbursement by HRSA date Insurance or Medicaid Eligible date* Date of Refund to HRSA 10/16/2020 $383 12/31/2020 2/3/2021 2/17/2021 3/11/2022 8/20/2020 $485 9/8/2020 9/23/2020 9/10/2020 3/11/2022 8/7/2020 $770 12/29/2020 1/28/2021 12/29/2020 3/11/2022 12/13/2020 $636 12/31/2020 2/3/2021 2/1/2021 3/11/2022 10/7/2020 $688 1/4/2021 2/4/2021 12/28/2020 3/11/2022 12/7/2020 $498 2/1/2021 3/3/2021 3/2/2021 3/11/2022 4/15/2020 $100 12/16/2020 12/29/2020 1/22/2021 4/7/2022 *This date indicates the date the patient became eligible and was approved for insurance coverage. In all instances, the patients obtained Medicaid coverage that was backdated to a date prior to the date of service. Cause Management does not have a process in place to identify patients with insurance applied retroactively and whether reimbursement requests should be canceled or refunded to HRSA for reimbursements already received. The Medical Center failed to identify these patients obtained backdated insurance coverage as of the date of service through lack of an existing control around this process. Effect Failure to appropriately identify patient eligibility as uninsured at the time the services were provided could result in inappropriate funds reimbursed from HRSA. Questioned Costs $3,560. Recommendation We recommend the Medical Center enhance its controls and revise its procedures to ensure that any type of insurance, including retroactively applied insurance, is identified and funds are returned in a timely manner when identified. Management?s Views and Corrective Action Plan Management?s response is included in ?Management?s View and Corrective Action Plan? at the end of this report.
Show full finding ▾Hide full finding ▴Finding 2021-002 ? Claim reimbursement for an uninsured patient was not reviewed for backdated Medicaid coverage Grantor: Health Resources and Services Administration (?HRSA?) Program: COVID-19 HRSA Claims for the Uninsured Program Assistance Listing #: 93.461 Title: HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Award Year: Fiscal year 2021 9/1/2020 ? 8/31/2021 Award Number: None listed Criteria In accordance with the Coronavirus Aid, Relief, and Economic Security Act and Paycheck Protection Program and Health Care Enhancement Act, HRSA offers reimbursement to providers and facilities for claims covering eligible uninsured individuals. Recipients should ensure that individuals covered by these funds were uninsured at the date of service. In order to provide additional context, background and clarification, the HRSA FAQs note the following: (https://www.hrsa.gov/coviduninsuredclaim/frequently-asked-questions - ?Do health care providers need to determine if an otherwise uninsured individual is Medicaid eligible??), ?Providers must verify and attest that to the best of the provider's knowledge at the time of claim submission, the patient was uninsured at the time the services were provided. For claims for COVID-19 testing and testing-related items and services, treatment of positive cases of COVID-19, and/or vaccine administration, this means that the patient did not have any health care coverage. Providers may submit a claim for uninsured individuals before Medicaid eligibility determination is complete. However, if the provider learns that the individual is retroactively enrolled in Medicaid as of the date of service, the provider must return the payment to HRSA?. Condition In testing compliance with the eligibility requirement, out of 60 claims selected to test patient eligibility, we identified seven claims, totaling $3,560 where patients were initially uninsured at the time of service, but subsequently became Medicaid eligible and this was not identified by the Medical Center?s processes and controls. It was determined in March and April 2022 that these patients should have been retroactively enrolled in Medicaid as of the date of service, which qualified the patients as insured at the date of service and therefore ineligible for HRSA reimbursement. The chart below outlines the details of each instance identified. Service Date HRSA Reimbursement Amount Date claim submitted to HRSA Reimbursement by HRSA date Insurance or Medicaid Eligible date* Date of Refund to HRSA 10/16/2020 $383 12/31/2020 2/3/2021 2/17/2021 3/11/2022 8/20/2020 $485 9/8/2020 9/23/2020 9/10/2020 3/11/2022 8/7/2020 $770 12/29/2020 1/28/2021 12/29/2020 3/11/2022 12/13/2020 $636 12/31/2020 2/3/2021 2/1/2021 3/11/2022 10/7/2020 $688 1/4/2021 2/4/2021 12/28/2020 3/11/2022 12/7/2020 $498 2/1/2021 3/3/2021 3/2/2021 3/11/2022 4/15/2020 $100 12/16/2020 12/29/2020 1/22/2021 4/7/2022 *This date indicates the date the patient became eligible and was approved for insurance coverage. In all instances, the patients obtained Medicaid coverage that was backdated to a date prior to the date of service. Cause Management does not have a process in place to identify patients with insurance applied retroactively and whether reimbursement requests should be canceled or refunded to HRSA for reimbursements already received. The Medical Center failed to identify these patients obtained backdated insurance coverage as of the date of service through lack of an existing control around this process. Effect Failure to appropriately identify patient eligibility as uninsured at the time the services were provided could result in inappropriate funds reimbursed from HRSA. Questioned Costs $3,560. Recommendation We recommend the Medical Center enhance its controls and revise its procedures to ensure that any type of insurance, including retroactively applied insurance, is identified and funds are returned in a timely manner when identified. Management?s Views and Corrective Action Plan Management?s response is included in ?Management?s View and Corrective Action Plan? at the end of this report.
Corrective Action Plan and Anticipated Completion Date: Management?s correction action plan includes: ? Review of HRSA uninsured claims received - Management completed a Medicaid eligibility check on all patients in which a HRSA uninsured reimbursement for Covid-19 was received. The Medical Center has begun to refund HRSA for these claims and anticipates having all funds returned by May 31, 2022. ? Future HRSA claims ? In addition to the changes within the registration team, Management will also complete a separate Medicaid eligibility verification check on a monthly basis for any patient with a HRSA uninsured payment. For any patients identified as having retroactive Medicaid coverage, a refund will be submitted back to HRSA. This monthly review will begin in May 2022 and continue moving forward.
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