Corrective Action Plans

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Finding 449983 (2022-005)
Significant Deficiency 2022
Finding 2022-005Federal Program InformationFederal Agency: United States Department of EducationFederal Cluster: Student Financial AssistanceAward Periods: July 1, 2021 through June 30, 2022, and July 1, 2022 through June 30, 2023Corrective Action PlannedAnnual cost of attendance budgets uploaded to...
Finding 2022-005Federal Program InformationFederal Agency: United States Department of EducationFederal Cluster: Student Financial AssistanceAward Periods: July 1, 2021 through June 30, 2022, and July 1, 2022 through June 30, 2023Corrective Action PlannedAnnual cost of attendance budgets uploaded to Mayo Clinic College of Medicine and Science?s student information system by the Program Manager of Student Financial Aid are reviewed and approved by another individual for accuracy once the upload is complete.Persons Responsible for Corrective ActionAnne Dahlen, Director of Student Financial Aid/Registrar Maribeth Foerster, Program Manager Student Financial AidTarget Completion DateSeptember 30, 2022
Finding 449982 (2022-004)
Significant Deficiency 2022
Finding 2022-004Federal Program InformationFederal Agency: United States Department of EducationFederal Cluster: Student Financial AssistanceAward Period: July 1, 2021 through June 30, 2022Corrective Action PlannedManagement retains evidence to support internal controls implemented as of July 1, 202...
Finding 2022-004Federal Program InformationFederal Agency: United States Department of EducationFederal Cluster: Student Financial AssistanceAward Period: July 1, 2021 through June 30, 2022Corrective Action PlannedManagement retains evidence to support internal controls implemented as of July 1, 2022, to document the review process performed for data submitted to the National Student Loan Clearinghouse, including the students sampled and specific data validated, the results of the review, and the follow-up actions taken, if any, and sign-off by the Financial Aid Director to evidence performance of the monthly review.Persons Responsible for Corrective ActionAnne Dahlen, Director of Student Financial Aid/Registrar Delores Henke, Assistant RegistrarTarget Completion DateJuly 1, 2022
Finding 449981 (2022-003)
Material Weakness 2022
Finding 2022-003Federal Program InformationFederal Agency: United States Department of EducationFederal Cluster: Student Financial AssistanceAward Periods: July 1, 2021 through June 30, 2022, and July 1, 2022 through June 30, 2023Corrective Action PlannedManagement agrees that Banner, the primary in...
Finding 2022-003Federal Program InformationFederal Agency: United States Department of EducationFederal Cluster: Student Financial AssistanceAward Periods: July 1, 2021 through June 30, 2022, and July 1, 2022 through June 30, 2023Corrective Action PlannedManagement agrees that Banner, the primary information system used to capture Federal Direct Loan information, was not specifically identified in the Mayo Clinic Information Security annual risk assessment which was primarily designed for compliance with The Health Insurance Portability and Accountability Act (HIPAA) Security rule.The following steps have been completed to address the gap identified:1. Compared the scope of the Mayo Clinic Information Security annual risk assessment and the requirements of the Department of Education, under the Gramm-Leach-Bliley Act and identified any gaps.2. Edited the existing annual risk assessment to close the gaps.3. Completed the risk assessment.Persons Responsible for Corrective ActionSarah Tyson, Senior Manager?Office of Information SecurityTarget Completion DateMay 31, 2023
Finding 449980 (2022-001)
Material Weakness 2022
Finding 2022-001Federal Program InformationFederal Agency: United States Department of EducationAssistance Listing Nos.: 84.063 and 84.268, Student Financial Assistance ClusterAward Periods: July 1, 2021 through June 30, 2022, and July 1, 2022 through June 30, 2023Corrective Action PlannedMayo Clini...
Finding 2022-001Federal Program InformationFederal Agency: United States Department of EducationAssistance Listing Nos.: 84.063 and 84.268, Student Financial Assistance ClusterAward Periods: July 1, 2021 through June 30, 2022, and July 1, 2022 through June 30, 2023Corrective Action PlannedMayo Clinic Information Technology will work with the Student Financial Aid office to review the risk rating of the Banner application. A complete user access review based on job roles will be completed for 2023. To improve the speed and accuracy of the completion of these requests, we will be working with the Identity Management Platform team to add the Banner application into SailPoint for access management and review.Persons Responsible for Corrective ActionAlec Haws, ETC Education Application Analyst Raj Sanwal, Lead IT Analyst/ProgrammerTarget Completion DateOctober 31, 2023
Finding 449964 (2022-012)
Significant Deficiency 2022
Subawards for SAPT Not Included in FFATA ReportsState Agency: Department of Health and Human ServicesFederal Program: Substance Abuse and Prevention ProgramThe Department concurs with this recommendation. We agree to properly report the subaward information beginning with SFY23.Anticipated Correcti...
Subawards for SAPT Not Included in FFATA ReportsState Agency: Department of Health and Human ServicesFederal Program: Substance Abuse and Prevention ProgramThe Department concurs with this recommendation. We agree to properly report the subaward information beginning with SFY23.Anticipated Correction Date: November 30, 2022Contact Person: Mark Meier, Financial Manager II, markmeier@utah.gov, and Kyle Larsen, Administrative Services Director, kblarson@utah.gov
Finding 449962 (2022-006)
Material Weakness 2022
Foster Care Eligibility Controls Not Completed in a Timely MannerState Agency: Department of Health and Human ServicesFederal Program: Foster Care Title IV-EThe Department concurs with this recommendation. The agency is in the process of building an integrated eligibility team and will increase its...
Foster Care Eligibility Controls Not Completed in a Timely MannerState Agency: Department of Health and Human ServicesFederal Program: Foster Care Title IV-EThe Department concurs with this recommendation. The agency is in the process of building an integrated eligibility team and will increase its capacity by having three team leads and one support coordinator III to support the eligibility review process.Anticipated Correction Date: June 30, 2023Contact Person: Tracy Wiggill, Eligibility Program Manager, twiggill@utah.gov
Finding 449949 (2022-011)
Significant Deficiency 2022
Sufficiently-Detailed PIC Meeting Minutes Not MaintainedState Agency: Department of Health and Human ServicesFederal Program: Medicaid ClusterThe Department concurs with this recommendation. The MOU between OIG and DIH/Medicaid and the PIC bylaws define that meeting minutes will be taken with each ...
Sufficiently-Detailed PIC Meeting Minutes Not MaintainedState Agency: Department of Health and Human ServicesFederal Program: Medicaid ClusterThe Department concurs with this recommendation. The MOU between OIG and DIH/Medicaid and the PIC bylaws define that meeting minutes will be taken with each PIC Committee. These meeting minutes will be reviewed at the following PIC Committee meeting and voted on for approval.PIC bylaws specifically state:?To keep written minutes of all Committee meetings, with assistance of staff, including:? Date, time, and place of meeting;? Names of members present, absent, and excused;? Substance of all matters proposed, discussed or decided and a record of votes taken;? Names of all other individuals who appeared and the substance in brief of their testimony;? Any other information that any member requests to be entered in the minutes.?Anticipated Correction Date: June 31, 2023Contact Person: Jennifer Strohecker, Director Division of Integrated Healthcare, jstrohecker@utah.gov
Finding 449948 (2022-010)
Significant Deficiency 2022
Medical Loss Ratio Report Lacked Two Required ElementsState Agency: Department of Health and Human ServicesFederal Program: Medicaid ClusterThe Department concurs with this recommendation. The Department will ensure that all required elements of the MLR are received by having DHHS staff review elem...
Medical Loss Ratio Report Lacked Two Required ElementsState Agency: Department of Health and Human ServicesFederal Program: Medicaid ClusterThe Department concurs with this recommendation. The Department will ensure that all required elements of the MLR are received by having DHHS staff review elements of the MLR to ensure they are complete.Anticipated Correction Date: January 31, 2023Contact Person: Gregory Trollan, Director, Office of Managed Health Care, gtrollan@utah.gov
Finding 449946 (2022-008)
Significant Deficiency 2022
Use of Appropriate National Correct Coding Initiative (NCCI) Edit Files Not VerifiedState Agency: Department of Health and Human ServicesFederal Program: Medicaid ClusterThe Department concurs with this recommendation. The Division successfully created and tested a comparison file. The division wil...
Use of Appropriate National Correct Coding Initiative (NCCI) Edit Files Not VerifiedState Agency: Department of Health and Human ServicesFederal Program: Medicaid ClusterThe Department concurs with this recommendation. The Division successfully created and tested a comparison file. The division will continue to work to resolve audit concerns. Implementation in production is set for November 2022.Anticipated Correction Date: November 30, 2022Contact Person: Shandi Adamson, Director, Office of Medicaid Operations, shandiadamson@utah.gov
Finding 449879 (2022-005)
Significant Deficiency 2022
Federal Funds Received Were Not Disbursed or Refunded Within Required TimeframeState Agency: Utah State UniversityFederal Program: Student Financial Assistance ClusterUtah State University will change its process for requesting federal funds in advance. The Controller?s Office will down less than t...
Federal Funds Received Were Not Disbursed or Refunded Within Required TimeframeState Agency: Utah State UniversityFederal Program: Student Financial Assistance ClusterUtah State University will change its process for requesting federal funds in advance. The Controller?s Office will down less than the full amount of the estimated financial aid disbursement amounts to be issued to students, as calculated by the University?s Financial Aid Office at the first of each semester.The Controller's Office personnel will then review federal financial aid disbursements within three days of receiving the advance draw in order to return any undisbursed funds to the Department of Education within the required timeframe. Federal financial aid funds will then be drawn down on an on-going basis as additional federal financial aid funds are disbursed to students during the semester.Contact Person: Jennifer Jenkins, Manager of Sponsored Programs Accounting, 435-797-1077Completion date: October 31, 2022
Finding 449777 (2022-024)
Significant Deficiency 2022
Underlying Accounting Data Does Not Support Coronavirus Relief Fund Quarterly ReportsState Agency: Governor?s Office of Planning and BudgetFederal Program: Coronavirus Relief FundGOPB will continue to review its master CRF expenditure file and reconcile all reported CRF expenditures to FINET transa...
Underlying Accounting Data Does Not Support Coronavirus Relief Fund Quarterly ReportsState Agency: Governor?s Office of Planning and BudgetFederal Program: Coronavirus Relief FundGOPB will continue to review its master CRF expenditure file and reconcile all reported CRF expenditures to FINET transactions. The reconciliation will account for original expenditure transactions, CRF expenditures that are booked when agencies are reimbursed for eligible transactions, and FEMA reimbursements for expenditures charged to the CRF.Contact Person: Duncan Evans, Senior Managing Director of Budget and Operations, 801-538-1592Anticipated Correction Date: April 10, 2023
Program: HOME Investment Partnership Program (HOME)Finding: 2022-001Contact Person: April ApodacaFinancial Services OfficerDevelopment Services DepartmentPhone: (562) 570-6611Email: april.apodaca@longbeach.govPlanned Actions:The Development Services Department (Department) will securely file all...
Program: HOME Investment Partnership Program (HOME)Finding: 2022-001Contact Person: April ApodacaFinancial Services OfficerDevelopment Services DepartmentPhone: (562) 570-6611Email: april.apodaca@longbeach.govPlanned Actions:The Development Services Department (Department) will securely file all HOME monitoring documents and ensure it is accessible to multiple staff. As of June 27, 2023, thirteen of the fifteen non-compliant samples have been secured and communication has been sent to retrieve the remaining two from the developers. The final two samples are due on July 21, 2023, and we fully expect to show compliance documentation by that date. If the documents are not received by the due date, the Department will continue to communicate with the developers by telephone, mail, and email to provide second and third notices. If no response is submitted by the third notice (August 7, 2023) the Department will escalate the matter to the City Attorney?s Office to formally begin taking action for non-compliance
View Audit 313326 Questioned Costs: $1
2022-005 COVID-19-Coronavirus State and Local Fiscal Recovery Funds ? Assistance Listing No. 21.027Recommendation: We recommend that management review their policies and procedures to ensure that all monthly and quarterly reports are submitted timely, and the supporting documentation used to prepare...
2022-005 COVID-19-Coronavirus State and Local Fiscal Recovery Funds ? Assistance Listing No. 21.027Recommendation: We recommend that management review their policies and procedures to ensure that all monthly and quarterly reports are submitted timely, and the supporting documentation used to prepare the reports are retained for audit purposes.Explanation of disagreement with audit finding: There is no disagreement with the audit finding.Action taken in response to finding: The Office of Budget and Finance in conjunction with the Executive?s office of Government Reform and Strategic Initiative have partnered to establish best practice procedures surrounding the compilation, review and approval of the Coronavirus State and Local Fiscal Recovery Reporting to ensure reports are reviewed for accuracy, approved and submitted timely.Name(s) of the contact person(s) responsible for corrective action: Elisabeth Sachs and Rebecca LangPlanned completion date for corrective action plan: 4/1/2023
2022-004 COVID-19-Emergency Rental Assistance ? Assistance Listing No. 21.023Recommendation: We recommend that management review their policies and procedures to ensure that all monthly and quarterly reports showing timely submission and the supporting documentation used to prepare the reports are r...
2022-004 COVID-19-Emergency Rental Assistance ? Assistance Listing No. 21.023Recommendation: We recommend that management review their policies and procedures to ensure that all monthly and quarterly reports showing timely submission and the supporting documentation used to prepare the reports are retained for audit purposes.Explanation of disagreement with audit finding: DHCD possesses and utilized supporting documentation to prepare the required reports. However, DHCD was provided 24 hours to submit this information while the primary contributing staff was on scheduled leave and unreachable. DHCD disagrees with the statement about monthly and quarterly reports not being submitted timely. All required reports were submitted on-time and in accordance with current Treasury guidance at the time of submission. DHCD cannot ascertain the veracity of this statement about lack of supporting documentation because it was not provided the data points the auditors used to make their determination. Fully reconciled final documentation of ERA1 Participant Household Data Report was given to the Auditors. However, this data would not have matched earlier submissions to Treasury. Treasury requested full revisions because their staff became aware of many structural reporting problems were experienced by recipients while completing the reporting actions. Entries timed out, sometimes disappeared, sometimes double counted, and the database had no ability to allow for corrections once identified. For this reason, Treasury?s final reporting requirements for closeout had the option for jurisdictions to disregard all prior entries and submit a reconciled version of the households assisted and all related expenditures. This final data report was provided in this audit yet it does not match the initial submissions for the reasons stated. Because the Auditors did not afford DHCD the time to review their ?findings?, DHCD cannot ascertain the level of agreement with the statement.Action taken in response to finding: Not applicable, see above.Name(s) of the contact person(s) responsible for corrective action: Colleen MahonyPlanned completion date for corrective action plan: Not applicable, see above.
Corrective Action Plan: The Executive Director and Senior Director of Finance will ? fully document process and procedures for completing the SEFA. Checklists to support significant completion of closing in January each year. Improvement put in place for 2022 did not completely address issues. Impro...
Corrective Action Plan: The Executive Director and Senior Director of Finance will ? fully document process and procedures for completing the SEFA. Checklists to support significant completion of closing in January each year. Improvement put in place for 2022 did not completely address issues. Improve system usage in developing SEFA reports and if necessary, engage outside consultants.Anticipated Completion Date of Corrective Action Plan: Procedure update with be completed by Sep 2023.
2022-001- Claims Auditor ProcessCondition: During three months of the 2021 ? 2022 fiscal year, certain checks were issued and mailed before being approved through the claims audit process. It is noted that the claims audit process took place after the fact and it appears that the three way matching...
2022-001- Claims Auditor ProcessCondition: During three months of the 2021 ? 2022 fiscal year, certain checks were issued and mailed before being approved through the claims audit process. It is noted that the claims audit process took place after the fact and it appears that the three way matching process was in place.Recommendation: We recommend the District identify, appoint and properly train an individual to perform the claims audit function in the absence of the primary claims auditor. We also recommend that the District retain supporting documentation of the claims auditor?s review date for each batch of disbursements and no disbursement be release without proper vetting through the required claims audit process.Action Taken: The district hired a retired accounts payable clerk (M. Button) to act as a backup claims auditor when our primary internal claims auditor is not available. All required training was provided.Implementation: September 15, 2022
FINDING 2022-005Contact Person Responsible for Corrective Action: Lynn Leininger, Business ManagerContact Phone Number: (260) 367-3677Whitko Community Schools concurs with the finding and will implement internal controls for all grantrequirements and reporting compliances of the Education Stabilizat...
FINDING 2022-005Contact Person Responsible for Corrective Action: Lynn Leininger, Business ManagerContact Phone Number: (260) 367-3677Whitko Community Schools concurs with the finding and will implement internal controls for all grantrequirements and reporting compliances of the Education Stabilization Funds. All reporting will be a jointeffort between the Business Manager preparing the reports with the assistance of the business officepersonnel. Supporting paperwork and calculations will be maintained to support all report informationsubmitted. Prior to submission of Education Stabilization Funds, all information will be reviewed andsigned by the Deputy Treasurer to insure reporting compliance.The completion date for this corrective action will be May1, 2023.INDIANA STATE
FINDING 2022-003Contact People Responsible for Corrective Action: Lynn Leininger, Business Manager and AllisonKellogg, Director of Special EducationContact Phone Number: (260) 367-3677Whitko Community Schools concurs with the finding and will implement a dual check system with theBusiness Manager an...
FINDING 2022-003Contact People Responsible for Corrective Action: Lynn Leininger, Business Manager and AllisonKellogg, Director of Special EducationContact Phone Number: (260) 367-3677Whitko Community Schools concurs with the finding and will implement a dual check system with theBusiness Manager and the Director of Special Education. All proportionate money earmarked fornonpublic school expenditures under the Special Education Cluster will be continually monitored from theapproval through the end of the grant to insure all compliance requirements are met.The completion date for this corrective action will be July 1, 2023.
Finding 443057 (2022-003)
Material Weakness 2022
FINDING 2022-003Contact Person Responsible for Corrective Action: Lisa Mullaney Clerk/TreasurerContact Phone Number: 574-892-5717 x222.Views of Responsible Official: I concur with the findings.Description of Corrective Action Plan:The Clerk-Treasurer will review all reports submitted by the 3rd part...
FINDING 2022-003Contact Person Responsible for Corrective Action: Lisa Mullaney Clerk/TreasurerContact Phone Number: 574-892-5717 x222.Views of Responsible Official: I concur with the findings.Description of Corrective Action Plan:The Clerk-Treasurer will review all reports submitted by the 3rd party grant writer with documentation.Anticipated Completion Date: 09/30/2023
2022-008 N. Special Tests and ProvisionsEducation Stabilization Fund CFDA #84.425Material Weakness in Internal Control over Compliance and Material Instance of NoncomplianceFinding Summary: During the course of the engagement, it was identified that the School didnot satisfy the requirements of 2 C...
2022-008 N. Special Tests and ProvisionsEducation Stabilization Fund CFDA #84.425Material Weakness in Internal Control over Compliance and Material Instance of NoncomplianceFinding Summary: During the course of the engagement, it was identified that the School didnot satisfy the requirements of 2 CFR 656.40 through 2 CFR 656.41. The School did not ensure proper inclusion of prevailing wage rate clauses were included in a construction contract and also did not obtain proper support to ensure required certified payrolls were submitted.Corrective Action Plan: The School will review internal controls surrounding required contract language and documentation supporting certified payroll reports are obtained from contractor.Anticipated Completion Date: June 30, 2023
Finding 2022-005 ReportingThe Corporation management agreed with the finding. As of August 15, 2023, the Corporation will remove any individual submissions from the general submission and reconcile the general submission to the supporting documentation less these individual submissions. The Corporat...
Finding 2022-005 ReportingThe Corporation management agreed with the finding. As of August 15, 2023, the Corporation will remove any individual submissions from the general submission and reconcile the general submission to the supporting documentation less these individual submissions. The Corporation does not expect to receive any further funding from the ARP or PRF and has no further reporting requirements under this grant.Responsible Personnel include Harley McCoige, Controller, Cortney Couture, Director of Accounting, and Samantha Pratt, Director of Internal audit.
Finding 2022-002 ? EligibilityA qualified opinion was issued for Assistance Listing 93.011 as the auditors noted that the Corporation expended the full balance of gift cards purchased during the fiscal year 2022 rather than the amount that was distributed to eligible participants. Participants are e...
Finding 2022-002 ? EligibilityA qualified opinion was issued for Assistance Listing 93.011 as the auditors noted that the Corporation expended the full balance of gift cards purchased during the fiscal year 2022 rather than the amount that was distributed to eligible participants. Participants are eligible to participate in the program and receive a gift card if they received a COVID-19 vaccine.Compliance with the eligibility requirements is the responsibility of Kimberly Green Reeves, Executive Director of Community Impact and the grant coordinator. As grants G32HS42634C6 and U3SHS45317C6 ended May 31, 2023, and July 31, 2023, respectively, no further correction action will be taken. However, effective August 15, 2023, if future programs are awarded Beacon Health System (the Corporation) will track the total gift cards purchased as a prepaid expense and expense the gift cards at the time they are distributed to eligible participants. The Corporation Finance will work with the grant administrator to obtain the total amount of gift cards purchased and have that recorded as a prepaid asset. Each month the Corporation Finance will work with the grant administrator to obtain a schedule showing the total amount of gift cards distributed, which will be used to record the appropriate expense each month.
View Audit 312518 Questioned Costs: $1
Finding 2022-001 Scope Limitation ? EligibilityA scope limitation qualified opinion was issued for Assistance Listing 10.557 as the auditors were unable to obtain sufficient documentation supporting the compliance of the Corporation regarding eligibility. The Corporation uses a paperless system as s...
Finding 2022-001 Scope Limitation ? EligibilityA scope limitation qualified opinion was issued for Assistance Listing 10.557 as the auditors were unable to obtain sufficient documentation supporting the compliance of the Corporation regarding eligibility. The Corporation uses a paperless system as supported by the State of Indiana and the U.S. Department of Agriculture. Third-party documentation is reviewed by the Corporation at the time the initial eligibility determination of a WIC participant is made. However, due to the paperless system implemented in 2007, these records are not retained. The Corporation?s process for eligibility determination is as follows:1. A (potential) participant comes into the WIC clinic2. A clerk verifies information (by looking and checking the appropriate boxes on the screen)a. Proof of identification (driver?s license, birth certificate, hospital birth record, etc.)b. Proof of residence (bill, lease, driver?s license, etc.)c. Proof of incomei. Working ? 30 days of pay stubsii. Medicaid ? card needed3. All of the above information is entered into the State of Indiana?s systema. System automatically determines eligibilityi. If yes ? they continue with appointmentii. If no ? they get a letter explaining reason why (over income, etc.)Compliance with State of Indiana participant eligibility requirements is the responsibility of Leslie Miller, WIC Coordinator. As the Corporation follows the State of Indiana?s paperless system as described above, no further corrective action will be taken.
To ensure the charging of indirect costs to federal programs are at the elected de minimis amount of 10% and in the correct fiscal period, the UWGC Chief Financial Officer or the UWGC Senior Director of Finance will perform a secondary review of the calculation prepared by the Finance Manager. The ...
To ensure the charging of indirect costs to federal programs are at the elected de minimis amount of 10% and in the correct fiscal period, the UWGC Chief Financial Officer or the UWGC Senior Director of Finance will perform a secondary review of the calculation prepared by the Finance Manager. The review will take place prior to the final completion of the report to ensure that Federal funds are reported in the correct time period as well.
View Audit 312506 Questioned Costs: $1
Management will ensure that accrued expenses are reviewed in detail at grant year end to ensure only costs incurred prior to year end are accrued and reported as grant expenditures.
Management will ensure that accrued expenses are reviewed in detail at grant year end to ensure only costs incurred prior to year end are accrued and reported as grant expenditures.
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