Corrective Action Plans

Finding 61682 (2022-003)

Significant Deficiency 2022

WA

Reporting Allowable Costs / Cost Principles Significant Deficiency

Recommendation: We recommend the Organization enforce its policies and procedures around review of reports. Corrective Action: Management agrees with the recommendation. Program management will review existing process to ensure adequate review and documentation of review of funder reports. Person(s)...

Recommendation: We recommend the Organization enforce its policies and procedures around review of reports. Corrective Action: Management agrees with the recommendation. Program management will review existing process to ensure adequate review and documentation of review of funder reports. Person(s) Responsible for Corrective Action: Associate Director, Ending Poverty Anticipated Completion Date: March 31, 2023

View Audit 56963

Finding 61681 (2022-002)

Significant Deficiency 2022

United Way of King County

WA

Special Tests & Provisions Allowable Costs / Cost Principles Significant Deficiency

Recommendation: We recommend the organization enforce its policies for retention and review of records for each person enrolled in the program and strengthen review of payroll for the underlying records. Corrective Action: Management agrees with the recommendation. Corrective action taken includes p...

Recommendation: We recommend the organization enforce its policies for retention and review of records for each person enrolled in the program and strengthen review of payroll for the underlying records. Corrective Action: Management agrees with the recommendation. Corrective action taken includes preparation of and communication of standard operating procedures for enrollment, payroll set up, and member service agreement document review and retention. In addition, program management staff will conduct a secondary review of biweekly program payroll prior to submission, to ensure wage rate compliance with member service agreements. Person(s) Responsible for Corrective Action: Associate Director, Human Resources; Associate Director, Ending Poverty Anticipated Completion Date: March 31, 2023

View Audit 56963

Finding 61669 (2022-002)

Significant Deficiency 2022

Southern Oregon University

OR

Matching / Level of Effort / Earmarking § 200.303

Recommendation: We recommend that the University continue to review their reporting policies and procedures to ensure accurate and timely reporting. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned in response to finding: SOU has updated...

Recommendation: We recommend that the University continue to review their reporting policies and procedures to ensure accurate and timely reporting. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned in response to finding: SOU has updated our processing timeline and our policies to reflect the need for reporting in accordance with Department of Education regulations. Name of the contact person responsible for corrective action Agnes Maina, Director of Business Services & Controller Planned completion date for corrective action plan: June 30, 2023.

View Audit 56895

Finding 61601 (2022-001)

Significant Deficiency 2022

Menorah Park Center for Senior Living

OH

Questioned Costs Allowable Costs / Cost Principles Matching / Level of Effort / Earmarking

Menorah Park Center for Senior Living CORRECTIVE ACTION PLAN YEAR ENDED December 31, 2022 Identifying Number: Finding Number 2022-001 Finding: Menorah Park could not provide invoice support for two charges that were allocated to the major federal program selected for testing. Corrective Action...

Menorah Park Center for Senior Living CORRECTIVE ACTION PLAN YEAR ENDED December 31, 2022 Identifying Number: Finding Number 2022-001 Finding: Menorah Park could not provide invoice support for two charges that were allocated to the major federal program selected for testing. Corrective Actions Taken or Planned: The errors occurred during the early stages of our conversion to a new software platform (SAGE). We were in beginning our conversion from paper files to fully paperless files. In the new SAGE process, every expense inside our AP system requires document backup. This back up is attached within the system. This will prevent document retrieval errors in the future. Date of corrective action: 10/1/2020 Person Responsible: Lisa Johnson, Accounts Payable Supervisor

View Audit 56766 Questioned Costs: $1

Finding 61595 (2022-001)

Significant Deficiency 2022

New England Law / Boston

MA

Student Financial Aid Special Tests & Provisions Matching / Level of Effort / Earmarking

Finding ? Special Tests and Provisions: Enrollment Reporting ? Federal Direct Student Loan Program, Assistance Listing Number 84.268; June 30, 2022 Award Year; U.S. Department of Education Criteria or Specific Requirement Enrollment information, including the effective date of separation from the ...

Finding ? Special Tests and Provisions: Enrollment Reporting ? Federal Direct Student Loan Program, Assistance Listing Number 84.268; June 30, 2022 Award Year; U.S. Department of Education Criteria or Specific Requirement Enrollment information, including the effective date of separation from the institution, must be accurately reported within 30 days whenever attendance changes for a student, unless a roster will be submitted within 60 days. The changes include reductions or increases in attendance levels, withdrawals, graduations, and approved leaves-of absence. It is the institution?s responsibility, as a participant in the Title IV aid programs, to monitor and report these changes to the National Student Loan Data System (?NSLDS?). (NSLDS Enrollment Reporting Guide September 2021, and 34 CFR 685.309(b)) Condition Of the 40 students selected for enrollment reporting testing, two students within the sample were reported to NSLDS outside the maximum 60-day window. This was not a statistically valid sample. Views of Responsible Officials and Planned Corrective Actions The School concurs with the finding. The School intends to report student status changes at year end. Names of Contact Person Responsible for Corrective Action: Anne Marie Martorana, Chief Financial Officer Anticipated Completion Date: December 14, 2022

View Audit 54378

Finding 61466 (2022-001)

None 2022

Wisconsin Lutheran College, Inc.

WI

Questioned Costs Student Financial Aid Eligibility

AUDIT PERIODS: 7/1/21 TO 6/30/22 - A. COMMENTS ON FINDINGS AND RECOMMENDATIONS - FINDING 2022-001 - OVERAWARDED FEDERAL DIRECT SUBSIDIZED LOAN: DURING THE AUDIT, IT WAS NOTED THAT ONE STUDENT WAS OVERAWARDED A SUBSIDIZED LOAN. IT WAS RECOMMENDED THAT THE SCHOOL RETURN $762 IN SUBSIDIZED LOAN TO THE ...

AUDIT PERIODS: 7/1/21 TO 6/30/22 - A. COMMENTS ON FINDINGS AND RECOMMENDATIONS - FINDING 2022-001 - OVERAWARDED FEDERAL DIRECT SUBSIDIZED LOAN: DURING THE AUDIT, IT WAS NOTED THAT ONE STUDENT WAS OVERAWARDED A SUBSIDIZED LOAN. IT WAS RECOMMENDED THAT THE SCHOOL RETURN $762 IN SUBSIDIZED LOAN TO THE DEPARTMENT. THE INSTITUTION AGREES WITH THE FINDING. B. ACTIONS TAKEN OR PLANNED FINDING 2022-001 - STUDENTS ARE MANUALLY PACKAGED. ALTHOUGH THE CORRECT AMOUNT OF LOAN WAS PACKAGED $2,825, THE FACT THAT THE STUDENT WAS IN THE FINAL SEMESTER OF HIS PROGRAM WAS MISSED AND THE LOAN WASN'T PRORATED. THE LOAN WAS REALLOCATED IN THE CORRECT AMOUNTS OF $2,062 FEDERAL SUBSIDIZED LOAN AND $763 FEDERAL UNSUBSIDIZED LOAN THE SAME DAY WE WERE MADE AWARE OF THE ERROR. LOAN DISBURSEMENT REPORTS WILL CONTINUE TO BE MONITORED FOR STUDENTS - WITH SPECIAL EMPHASIS ON THOSE WHO ARE IN THE FINAL SEMESTER OF THEIR PROGRAM TO CONFIRM THAT THE LOAN ALLOCATION IS CORRECT.

View Audit 57022 Questioned Costs: $1

Finding 61463 (2022-002)

Significant Deficiency 2022

Sauk Prairie School District

WI

Procurement, Suspension & Debarment Subrecipient Monitoring Matching / Level of Effort / Earmarking

Finding #2022-002 ? Wage Rate Requirements Education Stabilization Fund ? ESSER II (#84.425D) and ESSER III (#84.425U) Federal Grantor ? U.S. Department of Education Pass-through Award Number ? 2022-565100-DPI-ESSERFII-163 and 2022-565100-DPI-ESSERFIII-165 Pass-through Entity ? Wisconsin Department ...

Finding #2022-002 ? Wage Rate Requirements Education Stabilization Fund ? ESSER II (#84.425D) and ESSER III (#84.425U) Federal Grantor ? U.S. Department of Education Pass-through Award Number ? 2022-565100-DPI-ESSERFII-163 and 2022-565100-DPI-ESSERFIII-165 Pass-through Entity ? Wisconsin Department of Public Instruction Condition: There was one Education Stabilization Fund construction project performed by a contractor. Grant expenditures for the projects totaled $996,123. (ESSER II - $554,294 and ESSER III $441,829). A prevailing wage clause was not included in the contracts as required. However, certified payrolls reports were received to ensure the contractors were paying prevailing wage rates. Criteria: Wage rate requirements apply to the Education Stabilization Fund when laborers and mechanics employed by contractors or subcontractors work on construction contracts more than $2,000. Laborers must be paid wages not less than those established for the locality of the project (prevailing wage rates) by the Department of Labor (DOL). Nonfederal entities shall include in their contracts subject to wage rate requirements a provision that the contractor or subcontractor comply with those requirements and the DOL regulations. This includes a requirement of the contractor or subcontractor to submit to the District weekly payrolls and a statement of compliance (certified payrolls). Cause: The District was not aware that the wage requirement applied to these construction projects during the bid process. After they became aware and before construction began they requested certified payrolls during construction to verify prevailing wages were paid. Effect: Potential for a contractor to not pay prevailing wage rates if that language was not in the agreed upon contract. Context: The air handling construction project began in January of 2022 but was bid out the prior year before the District was aware of the prevailing wage requirement. After becoming aware of the requirement, they verified the prevailing wage rate was being paid during construction of the project. Recommendation: Establish controls to comply with wage rate requirements related to the Education Stabilization Fund during the bid and contract process of all projects. Response: The District became aware of wage rate requirements after finishing the bidding process for the project. Before construction began the prevailing wage rate was verified to be paid and was verified through certified payrolls by the District. Before bidding any future construction projects more than $2,000, the request for bid and contract will include a prevailing wage rate clause. Certified payrolls will continue to be received for any such contracts. Contact Person: Kathy Stoltz Anticipated Completion: June 30, 2023

View Audit 56925

Finding 61453 (2022-003)

Material Weakness 2022

Central Kitsap School District No. 401

WA

Questioned Costs Subrecipient Monitoring Allowable Costs / Cost Principles

Finding ref number: 2022-003 Finding caption: The District overcharged indirect costs to the program and did not have adequate internal controls for ensuring compliance with wage rate requirements. Name, address, and telephone of District contact person: Paula Bailey, Executive Director of Business ...

Finding ref number: 2022-003 Finding caption: The District overcharged indirect costs to the program and did not have adequate internal controls for ensuring compliance with wage rate requirements. Name, address, and telephone of District contact person: Paula Bailey, Executive Director of Business Services P.O. Box 8 Silverdale, WA 98383 (360) 662-1650 Corrective action the auditee plans to take in response to the finding: To ensure correct indirect rate charges, the District will create a grant tracking sheet that will list all information needed to fill in the SEFA. The Grant tracking sheet will include: ? Grant Title ? Grant year ? Grant number ? Grant amount ? ALN number ? Granting agency ? Federal agency name ? Approved Indirect Rate In order to ensure compliance of wage rate requirements the district will ensure: 1. Weekly collection and review of Certified Payroll Reports (CPRs) with compliance statements for all active projects will be incorporated into the Capital Projects accounts payable process. 2. The CPRs collected will be accessible to all Capital Project staff members in electronic format as well as a newly created control document verifying the date of review and reviewer of each CPR submitted. 3. Requests for CPRs will be made to all contractors or subcontracts missing reports through the period for which work has been performed. 4. Monthly invoices and pay applications will not be processed until CPRs for the billing period are collected and reviewed. 5. CPR procedures will be included in the Pre-Construction Meeting Agenda for all projects with emphasis given to weekly CPR submittals. 6. Contracts will be reviewed to ensure applicable laws and regulations are included. 7. Ongoing contracts will be amended to include required federal language as required by Title 29 CFR, Section 5.5 Anticipated date to complete the corrective action: 8/31/2023

View Audit 56807 Questioned Costs: $1

Finding 61451 (2022-002)

Material Weakness 2022

Central Kitsap School District No. 401

WA

Subrecipient Monitoring Internal Control / Segregation of Duties Equipment & Real Property Management

Finding ref number: 2022-002 Finding caption: The District did not have adequate internal controls for ensuring compliance with wage rate requirements. Name, address, and telephone of District contact person: Paula Bailey, Executive Director of Business Services P.O. Box 8 Silverdale, WA 98383 (360)...

Finding ref number: 2022-002 Finding caption: The District did not have adequate internal controls for ensuring compliance with wage rate requirements. Name, address, and telephone of District contact person: Paula Bailey, Executive Director of Business Services P.O. Box 8 Silverdale, WA 98383 (360) 662-1650 Corrective action the auditee plans to take in response to the finding: In order to ensure compliance of wage rate requirements the district will ensure: 1. Weekly collection and review of Certified Payroll Reports (CPRs) with compliance statements for all active projects will be incorporated into the Capital Projects accounts payable process. 2. The CPRs collected will be accessible to all Capital Project staff members in electronic format as well as a newly created control document verifying the date of review and reviewer of each CPR submitted. 3. Requests for CPRs will be made to all contractors or subcontracts missing reports through the period for which work has been performed. 4. Monthly invoices and pay applications will not be processed until CPRs for the billing period are collected and reviewed. 5. CPR procedures will be included in the Pre-Construction Meeting Agenda for all projects with emphasis given to weekly CPR submittals. 6. Contracts will be reviewed to ensure applicable laws and regulations are included. 7. Ongoing contracts will be amended to include required federal language as required by Title 29 CFR, Section 5.5 Anticipated date to complete the corrective action: 8/31/2023

View Audit 56807

Finding 61449 (2022-001)

Material Weakness 2022

Family Service Senior Housing Corporation

CA

Matching / Level of Effort / Earmarking HUD Housing Programs Reporting

Family Service Senior Housing will file it's Single Audit Report annually to remain in compliance. This will be ensured by including the request in the Engagement Letter.

View Audit 56686

Finding 61423 (2022-001)

None 2022

Rensselaer Polytechnic Institute

NY

Student Financial Aid Reporting Procurement, Suspension & Debarment

Finding 2022-001 - Non-Compliance with Timely and Accurate Student Enrollment Change Submissions to the National Student Loan Data System (NSLDS) Grantor: U.S. Department of Education Program Name: Student Financial Assistance Cluster Award Names: Federal Pell Grant Program and Fe...

Finding 2022-001 - Non-Compliance with Timely and Accurate Student Enrollment Change Submissions to the National Student Loan Data System (NSLDS) Grantor: U.S. Department of Education Program Name: Student Financial Assistance Cluster Award Names: Federal Pell Grant Program and Federal Direct Loan Program Award Year: 7/1/2021 - 6/30/2022 Award Number: Not applicable Assistance Listing Numbers: 84.063 and 84.268 Rensselaer agrees with the finding and in concurrence with the recommendations has developed and is implementing the following corrective action plans: Rensselaer?s Registrar?s Office is working with Rensselaer?s IT Department (?EIS?) to validate the logic of the data parameters included within every enrollment file. Validation will include ensuring all student status changes are reported in the enrollment file, including retroactive changes even if the student is not enrolled in the current semester. Rajni Soharu, the Institute?s Registrar, is responsible for implementing this corrective action plan by March 31, 2023. As of the date of this report, the Registrar?s Office is now fully staffed and employees are trained on the student status change requirements and system usage. Additionally, Rensselaer?s Student Success Office will now communicate changes in student enrollment information to the Registrar?s Office in real-time through a shared file. The shared file will be updated by the Student Success Office as soon as they receive any new approved leave of absence or withdrawal information from Student Health Services or other departments. The Registrar?s Office will update the student?s enrollment information within the student information system within three business days of the change reported and ensure the student?s status change is timely and accurately submitted to the National Student Clearinghouse. Rajni Soharu, the Institute?s Registrar, in collaboration with members of the Student Success Office are responsible for implementing this corrective action plan by January 31, 2023. Eileen McLoughlin Vice President for Finance and CFO

View Audit 58547

Finding 61403 (2022-002)

None 2022

Trinity University

TX

Procurement, Suspension & Debarment Student Financial Aid Matching / Level of Effort / Earmarking

Corrective Action Plan Audit Finding Reference: 2022-002 Planned Corrective Action: In response to audit finding 2022-002, the current policy requires a master promissory note (MPN) to be stored in a locked, fireproof safe. We acknowledge there may have been gaps in internal controls during the...

Corrective Action Plan Audit Finding Reference: 2022-002 Planned Corrective Action: In response to audit finding 2022-002, the current policy requires a master promissory note (MPN) to be stored in a locked, fireproof safe. We acknowledge there may have been gaps in internal controls during the 1970s and 1980s resulting in the missing MPN. Since 2005, MPNs are electronically signed and maintained by ECSI, our third-party servicer. During 2022, Trinity submitted 154 loans to the Department of Education (DOE) for assignment. While the University did not have an MPN for nine of these loans, the DOE accepted all but one loan based on additional documentation provided in lieu of an MPN. To determine potential future exposure, the University reviewed paper files for the 25 borrowers with loans disbursed prior to 2005 and found only three additional borrowers with a missing MPN. If the University were required to purchase these loans from the DOE, the estimated purchase amount would be less than $30,000. Date of Remediation: October 2022 Contact Person Responsible: Clara Wells

View Audit 56931

Finding 61380 (2022-009)

Material Weakness 2022

City of Detroit, Michigan

MI

Subrecipient Monitoring Reporting Material Weakness

Finding Number: 2022-009 Federal Program, Assistance Listing Number and Name: ALN 93.914, Department of Health and Human Services, HIV Emergency Relief Project Grants Condition: Original Finding Description: The City controls did not result in the reporting of program income earned by subrecipients ...

Finding Number: 2022-009 Federal Program, Assistance Listing Number and Name: ALN 93.914, Department of Health and Human Services, HIV Emergency Relief Project Grants Condition: Original Finding Description: The City controls did not result in the reporting of program income earned by subrecipients to the funding agency and not reporting the program income and related expenditures in their general ledger and on the SEFA. Contact Person Responsible for Corrective Action: Regina Greear and Keisha Pierce Anticipated completion date: July 2023 Planned Corrective Action: The $4,800 Program Income was reported on the general ledger In FY22 and included in the final FY22 SEFA but after the notification from the auditors. The city will implement a Corrective Action Plan (AFCAP) to document the Program Income requirements, track all awards with program income to help ensure proper and accurate reporting and further training on Program Income requirements.

View Audit 49776

Finding 61337 (2022-001)

None 2022

Juniata College

PA

Student Financial Aid Subrecipient Monitoring Matching / Level of Effort / Earmarking

CORRECTIVE ACTION PLAN February 8, 2023 Juniata College respectfully submits the following corrective action plan for the year ended May 31, 2022. FINDING 2022-001 Corrective Action Taken: The Controller & Chief Financial Officer, in response to the finding of the incorrect rounding in the return to...

CORRECTIVE ACTION PLAN February 8, 2023 Juniata College respectfully submits the following corrective action plan for the year ended May 31, 2022. FINDING 2022-001 Corrective Action Taken: The Controller & Chief Financial Officer, in response to the finding of the incorrect rounding in the return to Title IV calculation, reviewed the FSA Handbook and communicated the finding with both the Director of Student Financial Planning and the Bursar. As a result, the Bursar updated the calculation spreadsheet to ensure that the calculation was rounding to three decimal places for the current academic year. The Senior Leadership Team was also apprised of the finding. Name of Contact Responsible for Corrective Action: Karla D. Wiser, CPA Anticipated Completion Date of Corrective Action: August 18, 2022

View Audit 56776

Finding 61334 (2022-001)

None 2022

Masshire North Central Workforce Board, Inc.

MA

Matching / Level of Effort / Earmarking

2022-001 20% Program Expenditures for Youth Work Experience Responsible Official Jeffrey Roberge, Executive Director Plan Detail Going forward, MNCWB will review contractual expenditures at the end of each quarter. If the MNCWB anticipates that less than 20% will be expended, the MNCWB will move f...

2022-001 20% Program Expenditures for Youth Work Experience Responsible Official Jeffrey Roberge, Executive Director Plan Detail Going forward, MNCWB will review contractual expenditures at the end of each quarter. If the MNCWB anticipates that less than 20% will be expended, the MNCWB will move funding back to MDCS and have the Career Center Business Services Representative assist in placing youth into employment. Anticipated Completion Date The corrective action is in the process of being implemented and expected to be completed in fiscal year 2023.

View Audit 56714

Finding 61324 (2022-004)

Material Weakness 2022

Sunrise Community for Recovery and Wellness, Inc.

NC

Matching / Level of Effort / Earmarking Material Weakness

U.S. Department of Health and Human Services The Substance Abuse and Mental Health Services Administration Block Grants for Prevention and Treatment of Substance Abuse ? Recovery Community Organization Grant Assistance Listing # 93.959 Finding: 2022-004 Name of contact person: Sue Polston, Executiv...

U.S. Department of Health and Human Services The Substance Abuse and Mental Health Services Administration Block Grants for Prevention and Treatment of Substance Abuse ? Recovery Community Organization Grant Assistance Listing # 93.959 Finding: 2022-004 Name of contact person: Sue Polston, Executive Director Corrective Action: Management of Sunrise Community for Recovery and Wellness, Inc. will formalize and implement written policies that comply with Uniform Guidance standards and will present the policies to the Board of Directors to be approved and adopted. Proposed Completion Date: Immediately

View Audit 54391

Finding 61322 (2022-002)

None 2022

Missaukee County

MI

Procurement, Suspension & Debarment Allowable Costs / Cost Principles Cash Management

Finding: 2022-002 ? Immaterial noncompliance ? Written policies required by the Uniform Grant Guidance Auditor Description of Condition and Effect: Although the County has processes in place to cover these areas, the County lacks formal written policies covering these areas. As a result of this con...

Finding: 2022-002 ? Immaterial noncompliance ? Written policies required by the Uniform Grant Guidance Auditor Description of Condition and Effect: Although the County has processes in place to cover these areas, the County lacks formal written policies covering these areas. As a result of this condition, the County did not fully comply with the Uniform Guidance applicable to the above noted grants. Auditor Recommendation: We recommend that the City ensures these policies are updated to conform with the Uniform Guidance as soon as practical, but no later than the end of fiscal year 2023. Corrective Action: We agree with the finding and will develop and implement written procedures required for federal awards.

View Audit 54614

Finding 61302 (2022-004)

Material Weakness 2022

Ochsner Lsu Health System of North Louisiana

LA

Internal Control / Segregation of Duties Reporting Matching / Level of Effort / Earmarking

Finding 2022-004: Internal control deficiency and noncompliance over the calculation of lost revenues attributable to coronavirus. Since the start of the Covid-19 pandemic, Ochsner LSU Health has coordinated efforts across multiple divisions throughout the organization to ensure compliance with the...

Finding 2022-004: Internal control deficiency and noncompliance over the calculation of lost revenues attributable to coronavirus. Since the start of the Covid-19 pandemic, Ochsner LSU Health has coordinated efforts across multiple divisions throughout the organization to ensure compliance with the Provider Relief Fund that included leveraging publicly available information, outside consultants, and an internal review prior to management sign off. Ochsner LSU Health will ensure that all calculations are documented with detail supporting information. An additional quality control measure will be implemented whereby Ochsner?s Internal Audit Department will perform a detailed review of the calculation including tracing all formulas to ensure accuracy prior to management sign-off. In addition, Ochsner LSU Health will work with HRSA to understand the most appropriate manner to correct this issue within the Provider Relief Fund in the subsequent portal submissions. Responsible Official: Lauri Walton, Ochsner LSU Assistant Vice President of Accounting and Steven Stiles, Ochsner Vice President of Reimbursement Anticipated Completion Date: September 30, 2023

View Audit 49970

Finding 61301 (2022-003)

Material Weakness 2022

Ochsner Lsu Health System of North Louisiana

LA

Questioned Costs Internal Control / Segregation of Duties Reporting

Finding 2022-003: Internal control deficiency and noncompliance over reporting of expenses attributable to coronavirus in the HRSA PRF Reporting Portal. Since the start of the Covid-19 pandemic, Ochsner LSU Health has coordinated efforts across multiple divisions throughout the organization to ensu...

Finding 2022-003: Internal control deficiency and noncompliance over reporting of expenses attributable to coronavirus in the HRSA PRF Reporting Portal. Since the start of the Covid-19 pandemic, Ochsner LSU Health has coordinated efforts across multiple divisions throughout the organization to ensure compliance with the Provider Relief Fund that included leveraging publicly available information, outside consultants, and an internal review prior to management sign off. An additional level of review will be implemented whereby Ochsner?s Internal Audit Department will preview the preliminary HRSA PRF Report from the PRF Reporting Portal prior to submission to ensure expenses are not duplicated. In addition, Ochsner LSU Health will work with HRSA to understand the most appropriate manner to correct this issue within the Provider Relief Fund Portal. Responsible Official: Lauri Walton, Ochsner LSU Assistant Vice President of Accounting and Steven Stiles, Ochsner Vice President of Reimbursement Anticipated Implementation Date: September 30, 2023

View Audit 49970 Questioned Costs: $1

Finding 61226 (2022-005)

Material Weakness 2022

Mahaska County Hospital D/b/a Mahaska Health Partnership

IA

Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties § 200.327 § 200.328

Criteria: The Partnership must establish and maintain effective internal control over federal awards that provides reasonable assurance that the Partnership is managing the federal awards in compliance with federal statutes, regulations and terms and conditions of the federal award. 2 CFR 200.327 an...

Criteria: The Partnership must establish and maintain effective internal control over federal awards that provides reasonable assurance that the Partnership is managing the federal awards in compliance with federal statutes, regulations and terms and conditions of the federal award. 2 CFR 200.327 and 2 CFR 200.328 require the auditee to collect financial information and monitor its activities under federal awards to assure compliance with applicable federal requirements and performance expectations are being achieved and report these items in accordance with program requirements. Terms and conditions of the federal award require the Hospital to maintain a debt service reserve fund as bookkeeping accounts or as separate bank accounts. Condition: During 2022, the certificate of deposit that represented the debt service reserve fund matured and the proceeds were commingled with an existing money market fund. Planned Corrective Action: Management agrees with the finding and will deposit the required debt service reserve funds in a separate bank account. Planned Completion Date: June 30, 2023 Person Responsible: Daris Rosencrance, CFO

View Audit 50022

Finding 61225 (2022-004)

Material Weakness 2022

Mahaska County Hospital D/b/a Mahaska Health Partnership

IA

Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties § 200.327 § 200.328

Criteria: The Partnership must establish and maintain effective internal control over federal awards that provides reasonable assurance that the Partnership is managing the federal awards in compliance with federal statutes, regulations and terms and conditions of the federal award. 2 CFR 200.327 an...

Criteria: The Partnership must establish and maintain effective internal control over federal awards that provides reasonable assurance that the Partnership is managing the federal awards in compliance with federal statutes, regulations and terms and conditions of the federal award. 2 CFR 200.327 and 2 CFR 200.328 require the auditee to collect financial information and monitor its activities under federal awards to assure compliance with applicable federal requirements and performance expectations are being achieved and report these items in accordance with program requirements. Terms and conditions of the federal award require the audited financial statements to be provided to the federal agency annually within 150 days of fiscal year-end, as well as quarterly internal financial statements. Condition: The Partnership did not submit the audited financial statements within the prescribed period or request an extension and did not submit any quarterly reports to the federal agency. The Partnership was not asked for the information after they failed to submit it. The audited financial statements are readily available to the federal agency through the federal clearinghouse website. Planned Corrective Action: Management agrees with the finding and are implementing procedures to ensure that the required financial reports are submitted in a timely manner in accordance with the terms and conditions of the federal award. Planned Completion Date: June 30, 2023 Person Responsible: Daris Rosencrance, CFO

View Audit 50022

Finding 61122 (2022-003)

Significant Deficiency 2022

City of Las Vegas

NV

Allowable Costs / Cost Principles Cash Management Reporting

Finding 2022-003: Internal Controls Over Financial and Performance Reporting ? Significant Deficiency Management Response and Planned Corrective Action This finding relates to the absence of a signature and date indicating a management review before submission for reimbursement as evidence of an int...

Finding 2022-003: Internal Controls Over Financial and Performance Reporting ? Significant Deficiency Management Response and Planned Corrective Action This finding relates to the absence of a signature and date indicating a management review before submission for reimbursement as evidence of an internal control. Management concurs that there was no signature and date reviewed for submissions related to the Disaster Grants ? Public Assistance program. Management will implement a process where all submissions to federal agencies will be signed and dated prior to submission as an indication of internal control over the approval process.

View Audit 49725

Finding 61102 (2022-031)

Material Weakness 2022

State of New Hampshire

NH

Procurement, Suspension & Debarment Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

View of Responsible Officials We concur. The Department has contracted with Myers & Stauffer (M&S) to conduct the periodic audits of all three of its Managed Care plans for State Plan Rate Year 2020. We anticipate the audits will be completed by August 2023. Anticipated Completion Date: September ...

View of Responsible Officials We concur. The Department has contracted with Myers & Stauffer (M&S) to conduct the periodic audits of all three of its Managed Care plans for State Plan Rate Year 2020. We anticipate the audits will be completed by August 2023. Anticipated Completion Date: September 2023 Contact Person: Shirley Iacopino

View Audit 49723

Finding 61101 (2022-030)

Material Weakness 2022

State of New Hampshire

NH

Internal Control / Segregation of Duties Allowable Costs / Cost Principles Material Weakness

View of Responsible Officials We concur and have developed a corrective action plan in conjunction with Conduent. See attached plan. The SOC report will include auditing the change management of the quarterly NCCI edit checks. The auditing firm will also update the control objective 5 activities t...

View of Responsible Officials We concur and have developed a corrective action plan in conjunction with Conduent. See attached plan. The SOC report will include auditing the change management of the quarterly NCCI edit checks. The auditing firm will also update the control objective 5 activities to include a population of claims specifically with NCCI edits. Anticipated Completion Date: The completed 6/30/2023 SOC report. Contact Person: Roger Boissonneau, MMIS Director

View Audit 49723

Finding 61100 (2022-029)

Significant Deficiency 2022

State of New Hampshire

NH

Eligibility Matching / Level of Effort / Earmarking Subrecipient Monitoring

View of Responsible Officials 1. We concur. The Provider enrollment unit (PEU) is currently working on revalidations not completed and have a plan to deposition those providers while ensuring minimal disruption to member services and protecting limited provider networks disciplines such as the ment...

View of Responsible Officials 1. We concur. The Provider enrollment unit (PEU) is currently working on revalidations not completed and have a plan to deposition those providers while ensuring minimal disruption to member services and protecting limited provider networks disciplines such as the mental health network. I, the PEU administrator have been conducting biweekly meetings with Conduent and our business systems analyst to develop a plan and a systematic approach to revalidate all providers in the future. I am currently drafting a policy and procedure memo that will outline the new process for revalidations so that revalidations will be timely and complete in the future. Once the new process is implemented, I intend to review revalidations with Conduent at our biweekly provider enrollment meetings to ensure the revalidation process is conducted in a timely fashion and the implemented process for revalidations is working in that all revalidations are performed timely. As for the past due revalidations, the PEU anticipates all past due provider revalidations, prior to the PHE, to be either completed or be terminated by the beginning of March 2023. 2. We partially agree. The attestation signed in 2012 does not have an expiration and there is no Federal regulation or State law that requires this to be renewed, however, based on the finding last year, the Office of Medicaid Services did a new attestation in 2022. The 2022 attestation also does not have an end date and is not required to be renewed at any time. The attestation ends when the agreement is terminated by either parties. Anticipated Completion Date: March 2023 Contact Person: Stephanie Aulis

View Audit 49723

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