EIN: 410964895
UEI: GSA_MIGRATION
Data as of August 23, 2026
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on September 27, 2022. 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 March 27, 2023 (1246 days ago).
What is a management decision? →The reported expenses included expenses that had been reimbursed by other sources and were obligated to be reimbursed through Medicare and Medicaid cost-based reimbursement. Management also identified expenses eligible for reimbursement that were not reported in the PRF reporting portal. Cause: Controls in place did not operate effectively to substantiate that the funds were not reimbursed from other sources and other sources were not obligated to reimburse them. Additionally, controls in place did not identify all eligible expense meeting the terms and conditions of the award. Effect: Expenses reported included expense that were reimbursed or obligated to be reimbursed. Expenses reported excluded expenses that were eligible to be reimbursed by the award. Context: The error was present on the reporting submission completed for reporting period one. Recommendation: We recommend management review and strengthen its internal control review process over identification and tracking of eligible expenses and the reporting process. Views of responsible officials of the auditee: Management agrees with the finding, has prepared an assessment of the root causes of this deficiency and has developed a corrective action plan. Management also indicates that the expenses identified as reimbursable, but not reported in the PRF reporting portal, were sufficient to cover all funds received and recognized in the portal; eligible expenses exceeded the funds received and retained.
Show full finding ▾Hide full finding ▴Federal programs: U.S. Department of Health and Human Services, ALN 93.498 Criteria: 2 CFR Part 200.303(a) states that the auditee must establish and maintain effective internal control over the federal award that provides reasonable assurance that the auditee is managing the federal award in compliance with federal statutes, regulations, and terms and conditions of the federal award. Specific criteria are established by the U.S. Department of Health and Human Services (HHS) with respect to activities allowed or unallowed for this program, including: ? That these funds may not be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. Condition: The reported expenses included expenses that had been reimbursed by other sources and were obligated to be reimbursed through Medicare and Medicaid cost-based reimbursement. Management also identified expenses eligible for reimbursement that were not reported in the PRF reporting portal. Cause: Controls in place did not operate effectively to substantiate that the funds were not reimbursed from other sources and other sources were not obligated to reimburse them. Additionally, controls in place did not identify all eligible expense meeting the terms and conditions of the award. Effect: Expenses reported included expense that were reimbursed or obligated to be reimbursed. Expenses reported excluded expenses that were eligible to be reimbursed by the award. Context: The error was present on the reporting submission completed for reporting period one. Recommendation: We recommend management review and strengthen its internal control review process over identification and tracking of eligible expenses and the reporting process. Views of responsible officials of the auditee: Management agrees with the finding, has prepared an assessment of the root causes of this deficiency and has developed a corrective action plan. Management also indicates that the expenses identified as reimbursable, but not reported in the PRF reporting portal, were sufficient to cover all funds received and recognized in the portal; eligible expenses exceeded the funds received and retained.
Identifying Number: 2021-001 Finding: The reported expenses included expenses that had been reimbursed by other sources and were obligated to be reimbursed through Medicare and Medicaid cost-based reimbursement. Management also identified expenses eligible for reimbursement that were not reported in the Provider Relief Funds (PRF) reporting portal. Corrective Actions Taken or Planned: We were constantly learning more about the eligible expenses for the PRF. We tracked the potential universe of eligible expenses for all of our grants, but guidance and FAQs for PRF and other grants were constantly changing and continue to change. As a result, our understanding at the time of filing was different than our understanding now as to how to allocate eligible expenses. In terms of corrective action, we updated our policy and procedures related to PRF funds and Federal grants based on the information available at this time. We want to note that after consideration of amounts reimbursed by other sources and identification of previously unrecognized allowable expenses, we did not have any questioned cost and ultimately have allowable expenses beyond the amount of funds retained by the Hospital.
In The Cook Hospital?s Period 1 reporting in the PRF reporting portal, management reported lost revenue using Option ii, the difference between budgeted and actual patient care revenues. The amounts reported as budgeted revenues for each quarter of 2021 were from a budget covering only the period through December 31 2020. The Cook Hospital did not have a budget approved before March 27, 2020, that covered the entire period of availability. Therefore, The Cook Hospital?s calculation of lost revenue was inappropriately reported under Option ii and should have been reported under Option iii. Cause: In the preparation of the reports, the appropriate option for calculating lost revenue was not selected. Effect: The Cook Hospital?s reporting in the PRF reporting portal inaccurately described the method used to calculate lost revenue. Context: The error was present on the reporting submission completed for reporting period one. Questioned costs: None Recommendation: We recommend that internal controls be strengthened related to the reporting in the PRF portal. Views of responsible officials: The Hospital agrees with the above finding and its response is included in the corrective action plan.
Show full finding ▾Hide full finding ▴Finding 2021-002: Reporting Requirements Federal Program: U.S. Department of Health and Human Services, ALN 93.498 Criteria: 2 CFR Part 200.303(a) states that the auditee must establish and maintain effective internal control over the federal award that provides reasonable assurance that the auditee is managing the federal award in compliance with federal statutes, regulations, and terms and conditions of the federal award. 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: ? Entities may elect to calculate and report lost revenue using one of three options. For entities electing to report lost revenues using Option ii, the difference between budgeted and actual patient care revenues, budgets must be approved before March 27, 2020, and cover each quarter during the period of availability. Entities electing to calculate lost revenues using another reasonable method should report using Option iii. Condition: In The Cook Hospital?s Period 1 reporting in the PRF reporting portal, management reported lost revenue using Option ii, the difference between budgeted and actual patient care revenues. The amounts reported as budgeted revenues for each quarter of 2021 were from a budget covering only the period through December 31 2020. The Cook Hospital did not have a budget approved before March 27, 2020, that covered the entire period of availability. Therefore, The Cook Hospital?s calculation of lost revenue was inappropriately reported under Option ii and should have been reported under Option iii. Cause: In the preparation of the reports, the appropriate option for calculating lost revenue was not selected. Effect: The Cook Hospital?s reporting in the PRF reporting portal inaccurately described the method used to calculate lost revenue. Context: The error was present on the reporting submission completed for reporting period one. Questioned costs: None Recommendation: We recommend that internal controls be strengthened related to the reporting in the PRF portal. Views of responsible officials: The Hospital agrees with the above finding and its response is included in the corrective action plan.
Identifying Number: 2021-002 Finding: In the Hospital?s Period 1 reporting in the PRF reporting portal, the Hospital reported lost revenue using Option ii, the difference between budgeted and actual patient care revenues. The amounts reported as budgeted revenues for each quarter of 2021 were from a budget covering only the period through December 31 2020. The Hospital did not have a budget approved before March 27, 2020, that covered the entire period of availability. Therefore, the Association's calculation of lost revenue was inappropriately reported under Option ii and should have been reported under Option iii. Corrective Actions Taken or Planned: We have updated internal documentation to reflect the updated calculations of lost revenues. We updated our policy and procedures related to PRF funds and Federal grants based on the information available at this time.
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