EIN: 421347891
UEI: L8T8W9JMB2C6
Audited by: RSM US LLP
Oversight agency: 93 [Department of Health and Human Services]
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Data as of September 7, 2026
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on November 10, 2023. 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 May 10, 2024 (851 days ago).
What is a management decision? →FAC accepted this audit on March 30, 2023 — management decision was due September 30, 2023.
For the Medical Center?s Period 2 reporting in the HRSA PRF reporting portal, the Medical Center inaccurately reported lost revenues, resulting in an overstatement of lost revenues. Cause: Management did not have effective internal controls in place to ensure reporting of lost revenues were adequately reviewed before submission. Effect or potential effect: Quarterly revenues reported in the PRF reporting portal were misstated for several quarters, resulting in a total overstatement of actual 2019 revenues of $5,197,094, a total overstatement of actual 2020 revenues of $3,996,899, and a total understatement of 2021 actual revenues of $1,915,433. The total net impact of these misstatements to the lost revenue calculation resulted in an understatement of lost revenues reported of $1,903,535. The Medical Center also reported PRF expenses in Period 2 in an amount equal to Period 2 PRF funding received. Therefore, the Medical Center did not report actual revenue data for the third or fourth quarters of 2021. The portal included $100,237,417 of third and fourth quarter 2019 actual revenues in the calculated lost revenue for 2021. While reporting of lost revenue was inaccurate, there were no questioned costs. Questioned Costs: None Context: The Medical Center reported lost revenue using Option 1, comparing actual revenues for 2020 and 2021 to actual revenues for 2019. The Medical Center had errors in their formulas calculating actual revenue for the first quarter of 2019, second quarter of 2019, third quarter of 2019, and the second quarter of 2020. Additionally, the Medical Center used preliminary rather than final, audited actual revenue amounts for the second quarter of 2021. Whereas Period 2 PRF expenses were equal to Period 2 PRF distributions received and lost revenue was not needed to qualify for the Period 2 PRF distributions, the Medical Center did not submit actual revenue data for the third nor fourth quarter of 2021. As a result, the portal calculated a lost revenue amount for those quarters equal to actual revenues for the third quarter of 2019 and the fourth quarter of2019. Identification as a repeat finding, if applicable: No. Recommendation: We recommend that management develop and implement effective internal controls to ensure accurate reporting of quarterly revenue amounts in the portal. This will ensure the calculation of lost revenues complies with Terms and Conditions of the federal program. Views of responsible officials: Management agrees with the finding and recommendations.
Show full finding ▾Hide full finding ▴Finding 2022-001 ? Lost Revenue Reporting U.S. Department of Health and Human Services Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (93.498) Payments received during Period 2: July 1, 2020 to December 31, 2020 Criteria: Title 2, Subtitle A Chapter II Part 200 Subpart D 200.303 Internal controls. The non-Federal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). In addition, the terms and conditions of the award requires the recipient to submit reports as the secretary of the U.S. Department of Health and Human Services (HHS) determines are needed to ensure compliance with conditions that are imposed on the payment, and such reports shall be in such form, with such content, as specified by the secretary of HHS in future program instructions directed to all recipients. Specific criteria have been established by HHS in their terms and conditions related to allowable costs and reporting for this program including proper reporting of critical information, such as amounts included in reimbursed expense and lost revenues table. Condition: For the Medical Center?s Period 2 reporting in the HRSA PRF reporting portal, the Medical Center inaccurately reported lost revenues, resulting in an overstatement of lost revenues. Cause: Management did not have effective internal controls in place to ensure reporting of lost revenues were adequately reviewed before submission. Effect or potential effect: Quarterly revenues reported in the PRF reporting portal were misstated for several quarters, resulting in a total overstatement of actual 2019 revenues of $5,197,094, a total overstatement of actual 2020 revenues of $3,996,899, and a total understatement of 2021 actual revenues of $1,915,433. The total net impact of these misstatements to the lost revenue calculation resulted in an understatement of lost revenues reported of $1,903,535. The Medical Center also reported PRF expenses in Period 2 in an amount equal to Period 2 PRF funding received. Therefore, the Medical Center did not report actual revenue data for the third or fourth quarters of 2021. The portal included $100,237,417 of third and fourth quarter 2019 actual revenues in the calculated lost revenue for 2021. While reporting of lost revenue was inaccurate, there were no questioned costs. Questioned Costs: None Context: The Medical Center reported lost revenue using Option 1, comparing actual revenues for 2020 and 2021 to actual revenues for 2019. The Medical Center had errors in their formulas calculating actual revenue for the first quarter of 2019, second quarter of 2019, third quarter of 2019, and the second quarter of 2020. Additionally, the Medical Center used preliminary rather than final, audited actual revenue amounts for the second quarter of 2021. Whereas Period 2 PRF expenses were equal to Period 2 PRF distributions received and lost revenue was not needed to qualify for the Period 2 PRF distributions, the Medical Center did not submit actual revenue data for the third nor fourth quarter of 2021. As a result, the portal calculated a lost revenue amount for those quarters equal to actual revenues for the third quarter of 2019 and the fourth quarter of2019. Identification as a repeat finding, if applicable: No. Recommendation: We recommend that management develop and implement effective internal controls to ensure accurate reporting of quarterly revenue amounts in the portal. This will ensure the calculation of lost revenues complies with Terms and Conditions of the federal program. Views of responsible officials: Management agrees with the finding and recommendations.
Identifying Number: 2022-001 Finding: For the Medical Center?s Period 2 reporting in the HRSA PRF reporting portal, the Medical Center inaccurately reported lost revenues, resulting in an overstatement of lost revenues. Quarterly revenues reported in the PRF reporting portal were misstated for several quarters, resulting in a total overstatement of actual 2019 revenues of $5,197,094, a total overstatement of actual 2020 revenues of $3,996,899, and a total understatement of 2021 actual revenues of $1,915,433. The total net impact of these misstatements to the lost revenue calculation resulted in an understatement of lost revenues reported of $1,903,535. The Medical Center also reported PRF expenses in Period 2 in an amount equal to Period 2 PRF funding received. Therefore, the Medical Center did not report actual revenue data for the third or fourth quarters of 2021. The portal included $100,237,417 of third and fourth quarter 2019 actual revenues in the calculated lost revenue for 2021. While reporting of lost revenue was inaccurate, there were no questioned costs. Corrective Actions Taken or Planned: The Medical Center reported lost revenue using Option 1, comparing actual revenues for 2020 and 2021 to actual revenues for 2019. The Medical Center had errors in their formulas calculating actual revenue for the first quarter of 2019, second quarter of 2019, third quarter of 2019, and the second quarter of 2020. Additionally, the Medical Center used preliminary rather than final, audited actual revenue amounts for the second quarter of 2021. Due to the fact that Period 2 PRF expenses were equal to Period 2 PRF distributions received and lost revenue was not needed to qualify for the Period 2 PRF distributions, the Medical Center did not submit actual revenue data for the third nor fourth quarter of 2021 as the portal did not allow data entry beyond what was necessary to cover the Period 2 PRF distributions. As a result, the portal calculated a lost revenue amount for those quarters equal to actual revenues for the third quarter of 2019 and the fourth quarter of 2019. Management had previously added an additional layer of reporting review prior to submission, which includes the Chief Financial Officer, the Controller and the staff member responsible for submitting the information, which was implemented on March 24, 2022. However, this control did not detect previous formula errors. During the Period 4 reporting completed on March 28, 2023, the Controller and staff member corrected the prior formula errors and conducted a dual entry review as the information was reported into the portal. All errors, current and prior, have been corrected. Going forward, the Medical Center will implement checks to ensure that any information reported agrees to audited financial information. Anticipated completion date: March 28, 2023 Name of contact person responsible for corrective action: Gary Botine ? Vice President and Chief Financial Officer
FAC accepted this audit on September 29, 2022 — management decision was due March 29, 2023.
Management noted that the fringe benefit amount submitted in the PRF reporting portal had a reporting error. Cause: Management did not have effective internal controls in place to ensure COVID-eligible expenses were adequately reviewed before submission. Effect or potential effect: Fringe benefits were entered into the PRF reporting portal at a higher amount than actual expenses incurred. The calculation of expenses did not comply with the Terms and Conditions of the federal program, and total allowable costs reported in the PRF reporting portal as PRF reimbursed expenses were overstated by $100,120. Questioned Costs: $100,120 Context: While entering information into the system as part of the PRF reporting portal submission, the Medical Center mistakenly entered a fringe benefit amount of $133,268 instead of the correct amount of $33,148. The fringe benefits amount was calculated by multiplying eligible wages by their benefit ratio and the original calculation for Q1 2020 included contracted labor amounts that should not be included in the fringe benefit calculation. This error was detected by management, but after the information had already been submitted through the portal, and the portal did not allow management to correct a previous submission. Additional unreimbursed expenses of greater than $100,120 were also reported in the Period 1 portal submission, and therefore had the error been corrected, total corrected allowable costs still would have exceeded the amount of PRF payments received in Period 1. Identification as a repeat finding, if applicable: No. Recommendation: We recommend that management develop and implement effective internal controls to ensure accurate reporting in the Portal. This will ensure the calculation of expenses comply with Terms and Conditions of the federal program. Views of responsible officials: Management identified this error after submission of the Q1 2020 reporting; however, the portal did not allow access for corrections to be posted. This administrative error overstated total PRF reimbursed expenses reported in the portal. In future reporting periods, management will add an additional layer of reporting review before submission through the portal.
Show full finding ▾Hide full finding ▴Internal control deficiency and noncompliance over the calculation of allowable costs and reporting attributable to Coronavirus. Identification of the federal program: Assistance Listing Number 93.498 ? COVID-19 ? Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution ? U.S. Department of Health and Human Services ? Federal Award Identification Number ? Not Applicable ? Payments received during Period 1: April 10, 2020 to June 30, 2020 Criteria or specific requirement (including statutory, regulatory, or other citation): Title 2, Subtitle A Chapter II Part 200 Subpart D 200.303 Internal controls. The non-Federal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in ?Standards for Internal Control in the Federal Government? issued by the Comptroller General of the United States or the ?Internal Control Integrated Framework?, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). The terms and conditions of the award requires the recipient to submit reports as the secretary of HHS determines are needed to ensure compliance with conditions that are imposed on the payment, and such reports shall be in such form, with such content, as specified by the secretary of HHS in future program instructions directed to all recipients. Specific criteria have been established by the U.S. Department of Health and Human Services (HHS) in their terms and conditions related to allowable costs and reporting for this program including proper reporting of critical information, such as amounts included in reimbursed expense table. Condition: Management noted that the fringe benefit amount submitted in the PRF reporting portal had a reporting error. Cause: Management did not have effective internal controls in place to ensure COVID-eligible expenses were adequately reviewed before submission. Effect or potential effect: Fringe benefits were entered into the PRF reporting portal at a higher amount than actual expenses incurred. The calculation of expenses did not comply with the Terms and Conditions of the federal program, and total allowable costs reported in the PRF reporting portal as PRF reimbursed expenses were overstated by $100,120. Questioned Costs: $100,120 Context: While entering information into the system as part of the PRF reporting portal submission, the Medical Center mistakenly entered a fringe benefit amount of $133,268 instead of the correct amount of $33,148. The fringe benefits amount was calculated by multiplying eligible wages by their benefit ratio and the original calculation for Q1 2020 included contracted labor amounts that should not be included in the fringe benefit calculation. This error was detected by management, but after the information had already been submitted through the portal, and the portal did not allow management to correct a previous submission. Additional unreimbursed expenses of greater than $100,120 were also reported in the Period 1 portal submission, and therefore had the error been corrected, total corrected allowable costs still would have exceeded the amount of PRF payments received in Period 1. Identification as a repeat finding, if applicable: No. Recommendation: We recommend that management develop and implement effective internal controls to ensure accurate reporting in the Portal. This will ensure the calculation of expenses comply with Terms and Conditions of the federal program. Views of responsible officials: Management identified this error after submission of the Q1 2020 reporting; however, the portal did not allow access for corrections to be posted. This administrative error overstated total PRF reimbursed expenses reported in the portal. In future reporting periods, management will add an additional layer of reporting review before submission through the portal.
Finding: Fringe benefits were entered into the PRF reporting portal for PRF Period 1 at a higher amount than actual expenses incurred. The calculation of expenses did not comply with the Terms and Conditions of the federal program, and total allowable costs reported as PRF expenses in the PRF reporting portal were overstated by $100,120. Corrective Actions Taken or Planned: During the reporting submission for Period 2 PRF payments, management identified that the error stated above had been made. Management attempted to correct the previously reported amounts for Period 1, however, the portal did not allow access for corrections to be posted. Management has added an additional layer of reporting review prior to submission, which includes the Chief Financial Officer, the Controller and the staff member responsible for submitting the information, and this was implemented as of March 24, 2022. Any future reporting submissions will include this additional layer of reporting review. Name of contact person responsible for corrective action: Gary Botine - Vice President and Chief Financial Officer
Data source: This information comes from the Federal Audit Clearinghouse, the official repository of Single Audit data. All data is public domain. Verify this organization's audit history at fac.gov.
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