Mercy Hospital Iowa City, IANon-Profit

Finding No. 2022-002 Allowable Activities and Reporting Significant Deficiency in Internal Controls over Compliance Federal Program: Federal Financial Assistance Listing #93.498 US Department of Health and Human Services COVID-19 Provider Relief Fund Criteria: The terms and conditions of the CARES Act Provider Relief Fund (PRF) require funds received to be used to prevent, prepare for, and respond to coronavirus and that the payment shall reimburse the recipient only for health care related expenses and lost revenues that are attributable to the coronavirus. Condition: During the process of identifying expenses that were incurred to prevent, prepare for, or respond to the coronavirus pandemic, management included certain expense amounts that could not be substantiated as being incurred to prevent, prepare for, or respond to the coronavirus pandemic in the PRF submission. Cause: Management inadvertently included certain expenses as part of the Period 2 PRF Reporting Portal submission that could not be substantiated as being incurred to prevent, prepare for, or respond to the coronavirus pandemic as a result of an insufficient review of reported expenses. Effect: Management included expenses in the PRF Reporting Portal which were not allowable based on the terms and conditions of the PRF award. Questioned costs: Total questions costs amounted to $158,832 and were calculated based off expenses that were reported in the PRF Reporting Portal that could not be substantiated as being incurred to prevent, prepare for, or respond to the coronavirus pandemic. Context: During the audit, management identified costs related to two vendors in the amount of $41,805 and we identified one invoice out of 60 testing samples, of $117,027, that were reported in the PRF Reporting Portal submission and could not be substantiated as being incurred to prevent, prepare for, or respond to the coronavirus pandemic. Repeat finding: Yes Recommendation: We recommend that management continue to monitor and enhance its internal controls over federal award compliance to ensure that allowable costs included in the amount expended as reported in the PRF Reporting Portal are sufficiently reviewed to determine those expenses relate to those incurred to prevent, prepare for, or respond to the coronavirus pandemic. View of Responsible Official and Planned Corrective Action: Management agrees with the finding noted. However, Mercy also incurred and reported sufficient lost revenues in the PRF Reporting Portal that if the noted expenses were not to be reported, Mercy would have satisfactorily incurred eligible expenses and lost revenues in excess of the PRF funds received, including interest earned on such funds. See Corrective Action Plan.

Finding No. 2021-001 Allowable Activities and Reporting Significant Deficiency in Internal Controls over Compliance Federal Program: Federal Financial Assistance Listing #93.498 US Department of Health and Human Services COVID-19 Provider Relief Fund Criteria: The terms and conditions of the CARES Act Provider Relief Fund (PRF) require funds received to be used to prevent, prepare for, and respond to coronavirus and that the payment shall reimburse the recipient only for health care related expenses and lost revenues that are attributable to the coronavirus. Condition: During the process of identifying expenses that were incurred to prevent, prepare for or respond to the coronavirus pandemic, management included certain expense amounts twice in the PRF submission. Cause: Due to the amount of detailed information that was required to be compiled by management in order to enter data into the PRF Reporting Portal, management inadvertently included certain expenses twice. Effect: Management included amounts in the PRF Reporting Portal which were not eligible based on the terms and conditions of the PRF award. Questioned costs: Total questions costs amounted to $87,548 and were calculated based off amounts that were reported twice in the PRF Reporting Portal. Context: During the audit, it was determined that certain costs were included in duplicate in the PRF Reporting Portal submission. Recommendation: We recommend that management continue to monitor and enhance its internal controls over federal award compliance to ensure that eligible costs included in the amount expended are not double counted within the PRF Reporting Portal. Views of Responsible Official and Planned Correction Action: Management agrees with the finding noted. However, Mercy also incurred and reported sufficient lost revenue in the PRF Reporting Portal that if the noted expenses were not to be reported, Mercy would have satisfactorily incurred eligible expenses and lost revenue in excess of the PRF funds received, including interest earned on such funds. Management will continue to refine processes to more diligently review PRF Reporting Portal submissions to ensure duplicate expenses are not reported in future reporting.