Audit 40814

2022-004 Suspension and Debarment Federal Agency: US Department of the Treasury Federal Program Name: Coronavirus State and Local Fiscal Recovery Funds Assistance Listing Number: 21.027 Federal Award Identification Number and Year: Unknown Pass-Through Agency: Wisconsin Department of Health Services Pass-Through Number(s): 155811 Award Period: 3/3/2021-12/31/2024 Type of Finding: ? Significant Deficiency in Internal Control over Compliance ? Other Matter Criteria or Specific Requirement: 2 CFR Section 200.214 requires non-federal entities to follow suspension and debarment regulations outlined in 2 CFR part 180. When a nonfederal entity enters into a covered transaction with an entity at a lower tier, the nonfederal entity must verify that the entity, as defined in 2 CFR section 180.995 and agency adopting regulations, is not suspended or debarred or otherwise excluded from participating in the transaction. Condition: The County's Health Department verifies suspension and debarment status when there is a new vendor but did not continue to verify there was no change in that status in subsequent years when the vendor was used again. Questioned Costs: None Context: The one vendor used during 2022 that met the covered transaction threshold did not have any review completed by the County's public health department to ensure they were not suspended or debarred when initiating covered transactions in the current year. Cause: The County's Health Department misunderstood when verification of suspension and debarment status needs to be completed. Effect: County could contract with a vendor that has been suspended or debarred from receiving federal funds. Repeat Finding: Yes. The prior year finding was Finding 2021-004. Recommendation: We recommend the County use sam.gov or the ELPS listing to review clients prior to entering into procurement transactions in excess of the covered transaction threshold in accordance with the Uniform Guidance. We also recommend that there is a review of this documentation prior to approval of use of the vendor and that documentation of the search and approval is maintained. View of Responsible Officials: There is no disagreement with the audit finding.

2022-006 WIMCR Reporting Federal Agency: US Department of Health and Human Services Federal Program Name: Medical Assistance Program Assistance Listing Number: 93.778 Federal Award Identification Number and Year: Unknown Pass-Through Agency: Wisconsin Department of Health Services Pass-Through Number(s): WIMCR Award Period: 1/1/2022-12/31/2022 Type of Finding: ? Significant Deficiency in Internal Control over Compliance ? Other Matter Criteria or Specific Requirement: State single audit guidelines state that "each cost report documents costs incurred only by that program with no overlap or double counting" and "cost reports are supported by agency financial records." Review of the report and supporting documentation by someone other than the preparer prior to submitting the report is an internal control intended to prevent or decrease the occurrence of errors. Condition: The County files Wisconsin Medicaid Cost Reporting (WIMCR) annually with the State of Wisconsin. The County's Human Services department had turnover in various fiscal and management positions in 2021 and 2022. The preparation of the 2021 WIMCR cost report to be filed in 2022 was outsourced to a contracted employee who worked remotely. There was no review of the report by someone other than the prior to submission to the state was completed. Questioned Costs: None Context: While performing audit procedures, it was noted that no one reviewed the report prior to submitting the report to the state. When the county was working on the 2022 report and comparing to 2021, the human services fiscal manager noted errors in the hours reported for a few employees. Documentation of support used for report preparation was not retained by the County. County was able to reprint reports that materially matched what was reported. Cause: The Department does not have a review process to catch errors in WIMCR reporting, or to verify that the hours and costs reported matches supporting documentation. Effect: Reported expenditures may not reconcile to County's recorded general ledger expenditures and amounts may be over or under reported. Repeat Finding: No. Recommendation: We recommend the County develop and implement a process to require review and approval of the WIMCR reports prior to the submission of the report to the state to help ensure that the data reported are accurate, complete and supporting documentation is retained. View of Responsible Officials: There is no disagreement with the audit finding.

2022-004 Suspension and Debarment Federal Agency: US Department of the Treasury Federal Program Name: Coronavirus State and Local Fiscal Recovery Funds Assistance Listing Number: 21.027 Federal Award Identification Number and Year: Unknown Pass-Through Agency: Wisconsin Department of Health Services Pass-Through Number(s): 155811 Award Period: 3/3/2021-12/31/2024 Type of Finding: ? Significant Deficiency in Internal Control over Compliance ? Other Matter Criteria or Specific Requirement: 2 CFR Section 200.214 requires non-federal entities to follow suspension and debarment regulations outlined in 2 CFR part 180. When a nonfederal entity enters into a covered transaction with an entity at a lower tier, the nonfederal entity must verify that the entity, as defined in 2 CFR section 180.995 and agency adopting regulations, is not suspended or debarred or otherwise excluded from participating in the transaction. Condition: The County's Health Department verifies suspension and debarment status when there is a new vendor but did not continue to verify there was no change in that status in subsequent years when the vendor was used again. Questioned Costs: None Context: The one vendor used during 2022 that met the covered transaction threshold did not have any review completed by the County's public health department to ensure they were not suspended or debarred when initiating covered transactions in the current year. Cause: The County's Health Department misunderstood when verification of suspension and debarment status needs to be completed. Effect: County could contract with a vendor that has been suspended or debarred from receiving federal funds. Repeat Finding: Yes. The prior year finding was Finding 2021-004. Recommendation: We recommend the County use sam.gov or the ELPS listing to review clients prior to entering into procurement transactions in excess of the covered transaction threshold in accordance with the Uniform Guidance. We also recommend that there is a review of this documentation prior to approval of use of the vendor and that documentation of the search and approval is maintained. View of Responsible Officials: There is no disagreement with the audit finding.

2022-006 WIMCR Reporting Federal Agency: US Department of Health and Human Services Federal Program Name: Medical Assistance Program Assistance Listing Number: 93.778 Federal Award Identification Number and Year: Unknown Pass-Through Agency: Wisconsin Department of Health Services Pass-Through Number(s): WIMCR Award Period: 1/1/2022-12/31/2022 Type of Finding: ? Significant Deficiency in Internal Control over Compliance ? Other Matter Criteria or Specific Requirement: State single audit guidelines state that "each cost report documents costs incurred only by that program with no overlap or double counting" and "cost reports are supported by agency financial records." Review of the report and supporting documentation by someone other than the preparer prior to submitting the report is an internal control intended to prevent or decrease the occurrence of errors. Condition: The County files Wisconsin Medicaid Cost Reporting (WIMCR) annually with the State of Wisconsin. The County's Human Services department had turnover in various fiscal and management positions in 2021 and 2022. The preparation of the 2021 WIMCR cost report to be filed in 2022 was outsourced to a contracted employee who worked remotely. There was no review of the report by someone other than the prior to submission to the state was completed. Questioned Costs: None Context: While performing audit procedures, it was noted that no one reviewed the report prior to submitting the report to the state. When the county was working on the 2022 report and comparing to 2021, the human services fiscal manager noted errors in the hours reported for a few employees. Documentation of support used for report preparation was not retained by the County. County was able to reprint reports that materially matched what was reported. Cause: The Department does not have a review process to catch errors in WIMCR reporting, or to verify that the hours and costs reported matches supporting documentation. Effect: Reported expenditures may not reconcile to County's recorded general ledger expenditures and amounts may be over or under reported. Repeat Finding: No. Recommendation: We recommend the County develop and implement a process to require review and approval of the WIMCR reports prior to the submission of the report to the state to help ensure that the data reported are accurate, complete and supporting documentation is retained. View of Responsible Officials: There is no disagreement with the audit finding.