Corrective Action Plans

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Department: Defense, Veterans and Emergency Management Title: Internal control over DG – PA program financial reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will publish revised Federal financial reporting procedures. The De...
Department: Defense, Veterans and Emergency Management Title: Internal control over DG – PA program financial reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will publish revised Federal financial reporting procedures. The Department will train relevant staff. The Department will implement new Federal Financial Reporting procedures with increased staff resource allocations. Completion Date: April 30, 2026, June 30, 2026, and July 1, 2026, respectively Agency Contact: Sunny Cyr, MEMA Business Office Director, DVEM, 207-707-2507
Department: Health and Human Services Title: Internal control over Medicaid utilization control needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. This finding represents a mis...
Department: Health and Human Services Title: Internal control over Medicaid utilization control needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. This finding represents a misunderstanding of the applicable federal regulations and the state entity responsible for compliance. A Utilization Control (UC) program is the responsibility of the State Medicaid Agency as a whole, not the Program Integrity Unit (PIU). Additionally, there are many more federal regulations governing UC programs than cited by the Office of State Auditor (OSA) in the finding and touch on a host of controls that were not reviewed or considered in this audit. Moreover, the OSA appears to be basing findings on interpretations that are unsupported by the regulatory text cited. Second, the OSA confuses PIU's annual review plan (a yearly plan of focused program integrity areas of focus and review) with an agency-wide UC program: these are not the same, nor are they required to be. The Department's current processes for PIU's annual review plan were implemented in response to OSA findings in 2015 relating to an OSA finding that the Department was not fully utilizing available data analytics. In the intervening years, the OSA has not found Program Integrity's annual review plan, or the process of developing the plan, to be deficient. There has been no change in the Department's process or the regulation to justify the OSA's newly found position here. The OSA's criticism of PIU's use of data analytics contradicts a prior OSA findings on data analytics use, is contrary to accepted Department adjustments made in response, and represents a significant departure from federal guidance and industry standards around best practices for leveraging data analytics to prevent and detect improper payments and/or utilization. The PIU's annual review plan supplements post-payment reviews that PIU conducts based upon complaints and referrals. Finally, this finding’s singular focus on PIU's annual review plan fails to account for a myriad of other systems and processes the Department has in place to monitor utilization, including, but not limited to: 1. A contracted vendor (HMS) performing post-payment reviews of hospitals, nursing facilities, and other long-term care facilities; 2. MaineCare's Case Mix unit - performing look back reviews of documentation and services in nursing facilities and other long-term care units; 3. A contracted vendor (Acentra) reviewing authorization requests for behavioral health services and continuing stay reviews of services at designated intervals; 4. A contracted vendor (Maximus) that performs assessments and authorizations for nursing and personal care services; 5. A contracted vendor (Optum) that performs prior authorization reviews for pharmacy services and produces a variety of reports on drug utilization; 6. Fiscal intermediaries performing oversight and administrative support for self-directed services; 7. State staff who review and approve plans of care for Home and Community Based Waiver Services and conduct quality reviews of providers; 8. State staff performing quality assurance reviews of providers of mental and behavioral health services; 9. State staff monitoring and addressing inappropriate emergency department usage by beneficiaries; and 10. State staff with oversight and performing qualitative and quantitative reviews of a variety of programs operated under delivery service reform, including: Accountable Communities, Behavioral Health Homes, Certified Community Behavioral Health Clinics, Community Care Teams, MaineMOM, Opioid Health Homes, and Primary Care Plus. 11. State and contracted vendor (Gainwell) staff reviewing medical necessity and other allowability for medical services requiring prior authorization for initial requests and renewals. 12. A CMS-compliant Electronic Visit Verification (EVV) system, in accordance with Section 12006 of the 21st Century Cures Act, that ensures payment for applicable services is tied to an EVV record demonstrating that the service occurred; data from the system also contributes to post-payment reviews for applicable services. Completion Date: N/A Agency Contact: Michelle Probert, Director, Office of MaineCare Services, DHHS, 207-287-2093
Department: Administrative and Financial Services Title: Internal control over Medicaid SEFA reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The DHHS Service Center will update the internal SEFA procedure to include the step of removing app...
Department: Administrative and Financial Services Title: Internal control over Medicaid SEFA reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The DHHS Service Center will update the internal SEFA procedure to include the step of removing appropriations 0129, 0147 and 0148 from the subrecipient queries. The DHHS Service Center will update the reviewer's checklist for the SEFA to include a check that appropriations 0129, 0147 and 0148 are being excluded from subrecipient queries. The DHHS Service Center will add a note within the "Subrecipient" tab of the internal SEFA Cubes Workbook to exclude appropriations 0129, 0147 and 0148. Completion Date: February 20, 2026 (first item), and October 31, 2026 (second and third items) Agency Contact: Sarah Gove, Director, DHHS Service Center, DAFS, 207-458-6626
Department: Health and Human Services Title: Internal control over Medicaid drug rebates needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. Drug Rebate pre-invoicing and post-i...
Department: Health and Human Services Title: Internal control over Medicaid drug rebates needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. Drug Rebate pre-invoicing and post-invoicing is completed quarterly. As demonstrated during walkthroughs and during our meetings Maine completes specific tasks to ensure accuracy of the invoicing process. The pre-invoicing and post-invoicing procedures are documented in the Pharmacy Rebate Information Management System (PRIMS) Desk Level Procedure (DLP). The pre-invoicing work is performed by the State that compares drug utilization data to the number of dispensed units invoiced. Upon the completion of the pre-invoicing review approval is provided to the vendor allowing them to continue with the invoicing process. There is no requirement regarding how we select our sample of invoices to review. Based on OSA noting no exceptions to the drug rebate amounts, our system in place to review invoiced drug rebates is functioning as intended. Completion Date: N/A Agency Contact: Michelle Probert, Director, Office of MaineCare Services, DHHS, 207-287-2093
Department: Health and Human Services Title: Internal control over Medicaid Nursing Facility audits needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Director and Deputy director will meet biweekly to review the audit assignments and discuss the st...
Department: Health and Human Services Title: Internal control over Medicaid Nursing Facility audits needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Director and Deputy director will meet biweekly to review the audit assignments and discuss the status of the nursing facility audits. The Division of Audit management team will actively recruit for the ten vacant audit positions. The Deputy Director will adjust the audit procedures for the Nursing Facilities to limit the testing to just capital costs starting with the December 31, 2025, cost reports. The Department has assigned four of the seven current staff auditors to nursing facility audits. Completion Date: Ongoing (first and fourth items), June 30, 2026 (second item), and May 31, 2026 (third item) Agency Contact: Herb Downs, Director, Division of Audit, DHHS, 207-287-2403
Department: Health and Human Services Title: Internal control over the Adoption Assistance eligibility and benefit determination process needs improvement Questioned Costs: Known: $1,645 Likely: Undeterminable Status: Corrective action in progress Corrective Action: The Office of Child and Family Se...
Department: Health and Human Services Title: Internal control over the Adoption Assistance eligibility and benefit determination process needs improvement Questioned Costs: Known: $1,645 Likely: Undeterminable Status: Corrective action in progress Corrective Action: The Office of Child and Family Services made changes to the Katahdin System in August 2025 to stop duplicate payments. The Office of Child and Family Services will develop training information regarding children in adoption assistance agreements who are no longer receiving support from the adoptive parents. The Office of Child and Family Services will develop a training and train the appropriate staff. Completion Date: August 1, 2025, May 1, 2026, and December 31, 2026, respectively Agency Contact: Denise Merrill, Manager of Child Welfare Statewide Programs, DHHS, 207-822-2255
Department: Health and Human Services Administrative and Financial Services Title: Internal control over Foster Care and Adoption Assistance cash management needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The DHHS Financial Service Center will update...
Department: Health and Human Services Administrative and Financial Services Title: Internal control over Foster Care and Adoption Assistance cash management needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The DHHS Financial Service Center will update the IV-E cash on hand analysis to ensure the cash balances are tracked separately by each of the following Title IV-E programs: Foster Care, Adoption Assistance, Prevention Program and Guardianship Assistance. Completion Date: March 31, 2026 Agency Contact: Sarah Gove, Director, DHHS Service Center, DAFS, 207-458-6626
Department: Health and Human Services Title: Internal control over Foster Care level of care assessments needs improvement Questioned Costs: Known: $3,003 Likely: Undeterminable Status: Corrective action in progress Corrective Action: The Department will submit Katahdin system enhancements and Level...
Department: Health and Human Services Title: Internal control over Foster Care level of care assessments needs improvement Questioned Costs: Known: $3,003 Likely: Undeterminable Status: Corrective action in progress Corrective Action: The Department will submit Katahdin system enhancements and Levels of Care (LOC) report updates, to shorten timeframes, and schedule LOC assessments earlier, in order to meet 90-day and 12-month deadlines. The Department will work with vendors to shorten timeframes, to ensure assessments are completed timely. The Department will date and finalize Policy draft for Levels of Care for Resource Homes Chapter 14 with the Policy and Training unit. Completion Date: Jun 30, 2026 (first and second items) and December 31, 2026 (third item) Agency Contact: Robert Blanchard, Associate Director, OCFS, DHHS, 207-624-7955
Department: Health and Human Services Title: Internal control over the Foster Care and Adoption Assistance eligibility and benefit determination process needs improvement Questioned Costs: Known: Known: ALN 93.658 $51,247 ALN 93.659 $42,689 Likely: undeterminable Status: Corrective action complete C...
Department: Health and Human Services Title: Internal control over the Foster Care and Adoption Assistance eligibility and benefit determination process needs improvement Questioned Costs: Known: Known: ALN 93.658 $51,247 ALN 93.659 $42,689 Likely: undeterminable Status: Corrective action complete Corrective Action: The Department made changes to the OCFS licensing policy. The Department updated the Katahdin system (User story 3002158) to avoid overlapping payments for childcare in both Foster Care and Adoption. Completion Date: July 31, 2056, and August 3, 2025 Agency Contact: Robert Blanchard, Associate Director, OCFS, DHHS, 207-624-7955
Department: Health and Human Services Title: Internal control over CCDF subrecipient cash management needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. The Department is in com...
Department: Health and Human Services Title: Internal control over CCDF subrecipient cash management needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. The Department is in compliance with the requirement for minimizing the time between payments to our subrecipients and the disbursement of the funds. Payments are made as close as is administratively feasible. The Compliance Supplement suggested audit procedures for Cash Management for pass-through entities refers to 200.305(b)(1) ... that same paragraph states that the timing and amount of advance payments must be as close as is administratively feasible. Completion Date: N/A Agency Contact: Tara Williams, Associate Director of Early Care & Education, DHHS, 207-557-2342
Department: Health and Human Services Title: Internal control over CCDF eligibility determinations needs improvement Questioned Costs: None Status: Corrective action complete Corrective Action: The Department successfully addressed this issue and all QA functionality and processes are working as exp...
Department: Health and Human Services Title: Internal control over CCDF eligibility determinations needs improvement Questioned Costs: None Status: Corrective action complete Corrective Action: The Department successfully addressed this issue and all QA functionality and processes are working as expected as of July 2025 and ongoing. Completion Date: July 1, 2025 Agency Contact: Gina Forbes, Child Care Services Program Manager, DHHS, 207-592-0865
Department: Health and Human Services Title: Internal control over CCDF provider health and safety requirements needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Office of Child and Family Services (OCFS) will include an agenda item at the next Chi...
Department: Health and Human Services Title: Internal control over CCDF provider health and safety requirements needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Office of Child and Family Services (OCFS) will include an agenda item at the next Child Care Licensing Staff meeting, scheduled for 3/17/2026, to discuss all expectations related to timeframes/completion of annual unannounced inspections. The OCFS Child Care Licensing Supervisors will utilize the Baxter dashboard report for "latest correspondence yet to be posted" once weekly to ensure all documents ready for posting to the consumer education website have been posted. Completion Date: March 17, 2026, and April 1, 2026, respectively Agency Contact: Janet Whitten, OCFS, CLIS Program Manager, DHHS, 207-441-2259
Department: Health and Human Services Administrative and Financial Services Title: Internal control over CCDF financial reporting needs improvement Questioned Costs: None Status: Corrective action completed Corrective Action: The DHHS Financial Service Center enhanced policies and procedures for the...
Department: Health and Human Services Administrative and Financial Services Title: Internal control over CCDF financial reporting needs improvement Questioned Costs: None Status: Corrective action completed Corrective Action: The DHHS Financial Service Center enhanced policies and procedures for the CCDF grant by modifying the FSR Reviewer Checklist and adding an additional layer of FSR review. The DHHS Financial Service Center collaborated with OCFS to make reporting line determinations, complete corrective journal entries and submit Federal Financial Reports. Completion Date: April 30, 2025, and September 1, 2025, respectively Agency Contact: Sarah Gove, Director, DHHS Service Center, DAFS, 207-458-6626
Department: Health and Human Services Administrative and Financial Services Judicial Branch Title: Internal control over Child Support Services expenditures needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The DHHS and the Maine Judicial Branch will u...
Department: Health and Human Services Administrative and Financial Services Judicial Branch Title: Internal control over Child Support Services expenditures needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The DHHS and the Maine Judicial Branch will update the Cooperative Agreement to strengthen policies, procedures, and oversight in order to ensure that expenditures are based on actual costs. Completion Date: March 31, 2026 Agency Contact: Jerry Joy, Director, Division of Support Enforcement and Recovery, DHHS, 207- 624-6985
Department: Health and Human Services Title: Internal control over TANF work verification plan procedures needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will review and update ACF199/209 system processes within OFI and the ASPIRE Cont...
Department: Health and Human Services Title: Internal control over TANF work verification plan procedures needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will review and update ACF199/209 system processes within OFI and the ASPIRE Contractor to enhance existing procedures to ensure that information reported on the ACF-199/209 is accurate and complete prior to submission to the Federal government. This will include modifying existing SOP as necessary. The Department will enhance existing procedures and follow-up processes of the ACRT reviews to ensure that the reviews include information regarding the date the review was conducted and the dates on which any outstanding issues are resolved. The Department will review the Work Verification Plan to identify opportunities to improve the processes created to accurately record and report on work participation data. Completion Date: June 30, 2026 Agency Contact: Ian Yaffe, Director, Office for Family Independence, DHHS, 207-592-1481
Department: Health and Human Services Title: Internal control over TANF performance reporting procedures needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will review and update ACF199 system processes within OFI and the ASPIRE Contracto...
Department: Health and Human Services Title: Internal control over TANF performance reporting procedures needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will review and update ACF199 system processes within OFI and the ASPIRE Contractor to enhance existing procedures to ensure that information reported on the ACF-199 is accurate and complete prior to submission to the Federal government. This will include modifying existing SOPs as necessary. The Department will review the Work Verification Plan to identify opportunities to improve the processes created to accurately record and report on work participation data. Completion Date: June 30, 2026 Agency Contact: Ian Yaffe, Director, Office for Family Independence, DHHS, 207-592-1481
Department: Health and Human Services Title: Internal control over Income Eligibility and Verification System procedures needs improvement Questioned Costs: None Status: Corrective action complete Corrective Action: The Department has allocated TANF trained Eligibility Specialists to review the quar...
Department: Health and Human Services Title: Internal control over Income Eligibility and Verification System procedures needs improvement Questioned Costs: None Status: Corrective action complete Corrective Action: The Department has allocated TANF trained Eligibility Specialists to review the quarterly income discrepancy report effective SFY 2026. Completion Date: July 1, 2025 Agency Contact: Ian Yaffe, Director, Office for Family Independence, DHHS, 207-592-1481
Department: Health and Human Services Title: Internal control over TANF client payments needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will review and update standard operating procedures to ensure that support payments made to and on...
Department: Health and Human Services Title: Internal control over TANF client payments needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will review and update standard operating procedures to ensure that support payments made to and on behalf of TANF clients are accurate, allowable and adequately documented. Completion Date: June 30, 2026 Agency Contact: Ian Yaffe, Director, Office for Family Independence, DHHS, 207-592-1481
Department: Health and Human Services Title: Internal control over PDG subrecipient cash management needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. The Department is in comp...
Department: Health and Human Services Title: Internal control over PDG subrecipient cash management needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. The Department is in compliance with the requirement for minimizing the time between payments to our subrecipients and the disbursement of the funds. Payments are made as close as is administratively feasible. The Compliance Supplement suggested audit procedures for Cash Management for pass-through entities refers to 200.305(b)(1) ... that same paragraph states that the timing and amount of advance payments must be as close as is administratively feasible. Completion Date: N/A Agency Contact: Tara Williams, Associate Director of Early Care & Education, DHHS, 207-557-2342
Department: Education Title: Internal control over PDG special reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will update the FFATA Review Procedure to include review of passthrough funds. Completion Date: March 18, 2026 Age...
Department: Education Title: Internal control over PDG special reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will update the FFATA Review Procedure to include review of passthrough funds. Completion Date: March 18, 2026 Agency Contact: Nicole Denis, Director of Finance, DOE, 207-530-2161
Department: Health and Human Services Education Administrative and Financial Services Title: Internal control over PDG SEFA reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The DHHS Service Center will consult with OSC to help ensure our cur...
Department: Health and Human Services Education Administrative and Financial Services Title: Internal control over PDG SEFA reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The DHHS Service Center will consult with OSC to help ensure our current processes are correct and are designed to provide accurate information for the SEFA. The DHHS Service Center will update procedures and provide guidance/trainings as necessary to staff to ensure reporting of expenditure amounts for the SEFA is accurate. Completion Date: August 31, 2026 Agency Contact: Sarah Gove, Director, DHHS Service Center, DAFS, 207-458-6626
Department: Health and Human Services Title: Internal control over Health Disparities program subrecipient cash management needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. Th...
Department: Health and Human Services Title: Internal control over Health Disparities program subrecipient cash management needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. The Department is in compliance with the requirement for minimizing the time between payments to our subrecipients and the disbursement of the funds. Payments are made as close as is administratively feasible. The Compliance Supplement suggested audit procedures for Cash Management for pass-through entities refers to 200.305(b)(1) ... that same paragraph states that the timing and amount of advance payments must be as close as is administratively feasible. Completion Date: N/A Agency Contact: Eden Hale, Associate Director, Division of Population Health Equity, Maine CDC, 207-441-1090
Department: Administrative and Financial Services Health and Human Services Public Safety Title: Internal control over Health Disparities program cash management needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: Department of Health and Human Services ...
Department: Administrative and Financial Services Health and Human Services Public Safety Title: Internal control over Health Disparities program cash management needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: Department of Health and Human Services (DHHS): A revised MOU between the Maine CDC and the Department of Public Safety was completed to include the terms for reimbursement of grant funds to govern inter-departmental transfers of funds and ensure the timely processing of invoices. Department of Public Safety (DPS): The Department of Public Safety will draft a policy with clear timelines associated with the processing of invoices. The policy will be distributed to all Bureau Directors who will then share the policy internally within their respective bureaus. The MaineEMS Bureau will draft procedures for invoice processing which will be part of the onboarding process for all new employees within the bureau. Completion Date: DHHS: August 1, 2025 DPS: April 1, 2026 (first and second items), and April 15, 2026 (third item) Agency Contact: DHHS: Eden Hale, Associate Director, Division of Population Health Equity, Maine CDC, 207-441-1090 DPS: Derek Gorneau, Assistant to the Commissioner, DPS, 207-530-3531
Department: Administrative and Financial Services Title: Internal control over Health Disparities program SEFA reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Service Center will consult with OSC to help ensure our current processes are...
Department: Administrative and Financial Services Title: Internal control over Health Disparities program SEFA reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Service Center will consult with OSC to help ensure our current processes are correct and are designed to provide accurate information for the SEFA. The Service Center will update procedures and provide guidance and trainings as necessary to staff to ensure reporting of expenditure amounts for the SEFA is accurate. Completion Date: August 31, 2026 Agency Contact: Sarah Gove, Director, DHHS Service Center, DAFS, 207-458-6626
Department: Defense, Veterans and Emergency Management Administrative and Financial Services Title: Internal control over National Guard payroll costs needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: Defense, Veterans and Emergency Management (DVEM): ...
Department: Defense, Veterans and Emergency Management Administrative and Financial Services Title: Internal control over National Guard payroll costs needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: Defense, Veterans and Emergency Management (DVEM): The Department identified "agency heads" for the positions identified in the audit. The Department communicated to "agency heads" regarding the requirement to sign forms. Department of Administrative and Financial Services (DAFS): The Department will update the PMF guidance as part of ongoing modernization efforts. The Department will educate HR Staff in reviewing completed PMFs to ensure they are fully completed before processing. Completion Date: DVEM: March 2026 DAFS: August 1, 2026, and October 1, 2026, respectively Agency Contact: DVEM: Michelle Lenihan, Deputy Commissioner, DVEM, 207- 430-5997 DAFS: Michael J. Dunn, Esq., Acting State Human Resources Officer, BHR, 207- 215-2951
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