Cavalier County Memorial Hospital Association

Finding 2021-003 U.S. Department of Health and Human Services ALN #93.498 - Provider Relief Fund A - Activities Allowed or Unallowed & B - Allowable Costs/Cost Principles Condition: The Hospital’s internal controls over compliance related to reporting of allowable costs was not effective. Criteria: The Provider Relief Funds were provided under the Coronavirus Aid, Relief, and Economic Security Act (Pub. L. No. 116‐136, 134 Stat. 563) and are to be used to prevent, prepare for, and respond to coronavirus and that the funds shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus. Per the terms and conditions of the Provider Relief Fund, all records pertaining to expenditures under the Provider Relief Fund are required to be maintained for three years from the date of the final expenditure. Cause: The Hospital did not have information available to support the lost revenue computation as reported in the portal reporting. Effect: A prior chief financial officer prepared the provider relief portal reporting for period 1 prior to terminating employment at the Hospital and did not provide the Hospital with supporting records for the submitted report. The new chief financial officer had to reconstruct supporting records for lost revenues claimed. Based on the reconstructed supporting records, lost revenues utilized in period 1 were overstated in the portal reporting by approximately $585,000. However, the Hospital was able to identify additional covid expenses to sufficiently cover the overstated lost revenue amounts. Therefore, no funds were estimated to be due back to the Provider Relief Fund. Questioned Costs: None. Recommendation: The Hospital should maintain support for federal grant expenditures. We also recommend the Hospital include in its controls over expenditures of federal awards the process of having an individual familiar with the award review and approve grant expenditures and reporting documentation and periodically review or monitor guidance that may be published by federal grantors. Views of Responsible Officials: The Hospital agrees with the finding and has prepared a corrective action plan.

Finding 2021-004 U.S. Department of Health and Human Services ALN #93.498 - Provider Relief Fund L - Reporting Condition: The Hospital did not complete the audit required under Uniform Guidance for the year ended June 30, 2021, by the federal due date. Criteria: Uniform Guidance requires audits to be submitted the earlier of 30 days after audit issuance or 9 months after year end. Cause: Turnover in the chief financial officer position and staffing constraints at the Hospital limited the Hospital’s ability to be ready for audit. Effect: The audit was not completed prior to the federal due date. Recommendation: eThe Hospital should plan to have its audits completed prior to the federal due date. Views of Responsible Officials: The Hospital agrees with the finding and has prepared a corrective action plan to have future audits completed by the federal due date.