Corrective Action Plans

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The Organization has transitioned from QuickBooks to Sage Intacct accounting software, which now requires digital attachments for all transactions to ensure proper documentation. The Organization continues to review and improve processes and procedures as we grow as an organization. We will reinforc...
The Organization has transitioned from QuickBooks to Sage Intacct accounting software, which now requires digital attachments for all transactions to ensure proper documentation. The Organization continues to review and improve processes and procedures as we grow as an organization. We will reinforce adherence to the Organization's policies.
Finding 2025-007 Finding Summary: The OMB Supplement requires that reports submitted to the federal awarding agency include all activity of the reporting period, are supported by applicable accounting or performance records, and are fairly presented in accordance with governing requirements. The ann...
Finding 2025-007 Finding Summary: The OMB Supplement requires that reports submitted to the federal awarding agency include all activity of the reporting period, are supported by applicable accounting or performance records, and are fairly presented in accordance with governing requirements. The annual reported cumulative expenditures were overstated by $464,672, current period obligations were overstated by $3,059,105, and the current period expenditures were overstated by $610,505. Responsible Individuals: Richard Braithwaite, City Manager Corrective Action Plan: Management understands the importance of correcting this deficiency. Management is working on controls to establish a secondary reviewer requirement. All annual reports must be verified against source documentation (receipts, payroll registers, and contracts) by a staff member independent of the original data entry process prior to reports being submitted. Anticipated Completion Date: June 2026
Reference # and title: 2025-004 Internal Control over Allowable Costs Federal program and specific federal award identification: AL # Grant Year FEDERAL GRANTOR/ PASS-THROUGH GRANTOR/PROGRAM NAME Passed through Louisiana Department of Education Child Nutrition Cluster: School Breakfast Program 10.55...
Reference # and title: 2025-004 Internal Control over Allowable Costs Federal program and specific federal award identification: AL # Grant Year FEDERAL GRANTOR/ PASS-THROUGH GRANTOR/PROGRAM NAME Passed through Louisiana Department of Education Child Nutrition Cluster: School Breakfast Program 10.553 2025 National School Lunch Program 10.555 2025 Summer Food Program 10.559 2025 Criteria or specific requirement: 2 CFR section 200.430(g) requires that charges to Federal awards for salaries and wages must be based on records that accurately reflect the work performed. These records must support the distribution of the employee’s salary or wages among specific activities or cost objectives if the employee works on a Federal award and a non-Federal award. Condition found: No time certification was completed by Child Nutrition Supervisor for six months of the year. The Child Nutrition Supervisor retired in December 2024. Corrective action plan: Make a list of all employees who are paid by two budgets and require them to complete and sign time and effort sheets monthly. Person responsible for corrective action: Supervisors Anticipated completion date: Time and effort reports are to be reviewed monthly by supervisor and time and effort reports are to be kept on file by individual supervisors beginning school year 2025-2026.
Finding #: 2025-004 Allowable Activities and Cost - Payroll (Significant Deficiency, Other Noncompliance) Corrective Action Plan: Please describe below how the situation in the finding will be corrected. What action(s) will be done (refer to finding recommendation and agency response): Newly imposed...
Finding #: 2025-004 Allowable Activities and Cost - Payroll (Significant Deficiency, Other Noncompliance) Corrective Action Plan: Please describe below how the situation in the finding will be corrected. What action(s) will be done (refer to finding recommendation and agency response): Newly imposed supervisory review of the bi-weekly payroll correction process will ensure that miscoded employees are detected. Discrepancies will be addressed immediately. Who will act (name and title): Division Finance Directors, Program Grant Administrators, and Federal Grants Director. When will action(s) be completed (effective dates, timelines, etc.): The Department is working on remediation of this finding and anticipates completion before June 30, 2026.
2025-001 Period of Performance Recommendation: We recommend that the Center implement specific controls around cut off for expenditures to ensure expenditures are recorded in the proper period in accordance with the grant. Explanation of disagreement with audit finding: There is no disagreement with...
2025-001 Period of Performance Recommendation: We recommend that the Center implement specific controls around cut off for expenditures to ensure expenditures are recorded in the proper period in accordance with the grant. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned in response to finding: We will monitor expenditures closely to ensure expenditures are recorded in the proper period. Name(s) of the contact person(s) responsible for corrective action: Greg Miller Planned completion date for corrective action plan: April 2026 If the U.S. Department of Health and Human Services has questions regarding this plan, please call Greg Miller at 309-323-6609.
Finding - Special Reporting: Fiscal Operations Report and Application to Participate (FISAP) - Federal Work Study Program, Assistance Listing Number 84.033, Federal Supplemental Educational Opportunity Grants Program, Assistance Listing Number 84.007; June 30, 2025 Award Year; U.S. Department of Edu...
Finding - Special Reporting: Fiscal Operations Report and Application to Participate (FISAP) - Federal Work Study Program, Assistance Listing Number 84.033, Federal Supplemental Educational Opportunity Grants Program, Assistance Listing Number 84.007; June 30, 2025 Award Year; U.S. Department of Education Condition The graduate enrollment figure at Section D line 7(b) included an additional 51 students on the FISAP submitted on September 29, 2025. Corrective Actions During our compliance audit it came to light that New England Institute of Technology accidentally overstated the quantity of graduate students on our FISAP that was filed originally on September 29, 2025, by 51 students. We immediately revised the FISAP to make the correction and filed it with the Department of Education on December 9, 2025. New England Institute of Technology will implement a process to compare the system-generated enrollment reports to enrollment data to ensure enrollment information this is reported on the FISAP is accurate. Responsible Official: Denise Brindle, Financial Aid Director Completion Date: December 2025
Condition: Costs were charged to the grants for invoices with service dates prior to the start of the grant period and payroll and related benefits earned prior to the start of the grant period. Corrective Action Planned: We had budgeted the full cost of one teacher and four teaching assistances in ...
Condition: Costs were charged to the grants for invoices with service dates prior to the start of the grant period and payroll and related benefits earned prior to the start of the grant period. Corrective Action Planned: We had budgeted the full cost of one teacher and four teaching assistances in the IDEA 240 grant for 2025. The approval process for the grant took longer than expected, our intent was always to comply, but we do realize we should have waited for the approval to be in place prior to charging the costs of these employees to the grant. In the future we will wait for the approval process to be complete and will then charge the employees there. Anticipated Completion Date: Completed Contact: Martin Anguelov, Chief Financial Officer for Nantucket Public Schools and Deb Gately, Director of Special Education for Nantucket Public Schools
Material Weakness in Internal Control over Compliance and Compliance 2025-002 Special Tests and Provisions. Criteria The District is required to maintain records that support the removal of a student from the adjusted cohort, such as documentation to transfer to another diploma granting program, emi...
Material Weakness in Internal Control over Compliance and Compliance 2025-002 Special Tests and Provisions. Criteria The District is required to maintain records that support the removal of a student from the adjusted cohort, such as documentation to transfer to another diploma granting program, emigration, consistent with federal reporting requirements. Statement of Condition We identified instances in which the District had students removed from the adjusted cohort, but did not maintain sufficient written documentation to support the removal. Statement of Cause The District did not have adequate procedures to ensure that the documentation supporting adjusted cohort removals was obtained, reviewed, and retained. Possible Asserted Effect Without appropriate documentation supporting removal of students from the adjusted cohort, the District is unable to demonstrate compliance with federal record keeping requirements. Questioned Costs None noted. Context A sample of 25 students that had withdrawn was selected and 3 student files were not able to be provided. Repeat Finding: This is not a repeat finding. Recommendation We recommend that a process be implemented to ensure appropriate written documentation is maintained for all student withdraws. Views of responsible officials and planned corrective action To ensure compliance with this standard in the future, we have created a specific folder within our Student Information System for uploading and maintaining all withdrawal paperwork. All staff responsible for processing withdrawals have received instructions for this updated procedure via email and the guidance has also been added to the Secretary’s Manual.
Finding 1179425 (2025-001)
Material Weakness 2025
Anson County Finance Department 101 S. Greene Street, Suite 238 Wadesboro, NC 28170 None reported Name of Contact Person: Nia Broadway, Medicaid Manager Corrective Action: Proposed Completion Date: Corrective Actions for findings 2025-001 also apply to the State Award findings. Section IV- State Awa...
Anson County Finance Department 101 S. Greene Street, Suite 238 Wadesboro, NC 28170 None reported Name of Contact Person: Nia Broadway, Medicaid Manager Corrective Action: Proposed Completion Date: Corrective Actions for findings 2025-001 also apply to the State Award findings. Section IV- State Award Findings and Questioned Costs Section III - Federal Award Findings and Questioned Costs Corrective Action Plan 2/13/2026 Inadequate Request for Information Management will meet with staff on November 13, 2025, to discuss and train on findings from the Single County Audit All staff responsible for Single County Finding were placed on work plan related to the finding. For the next 60 days 50% of all Medicaid Staff work will have a complete Second Party and the findings will be discussed with the individual staff and training for all Staff based off the findings. For the Year Ended June 30, 2025 Section II - Financial Statement Findings Finding: 2025-001 124
Condition: The College did not send out the post-disbursement email notifications to a group of students. Planned Corrective Action: While the University has documented procedures in place for the disbursement of federal funds and required post-disbursement notifications to students, the finding ide...
Condition: The College did not send out the post-disbursement email notifications to a group of students. Planned Corrective Action: While the University has documented procedures in place for the disbursement of federal funds and required post-disbursement notifications to students, the finding identified related to only students who received both a Federal PLUS loan and a Federal Direct Loan during 2025. University did not properly send a post-disbursement notification to 117 out of 247 students who received both a federal PLUS loan as well as a Federal Direct Loan on a specific date during fiscal year 2024-2025. The University will adjust its internal processes to ensure all students who receive federal loans are sent post-disbursement email notifications by performing a review of the IT system and working toward fully automated notification settings to ensure all students are captured in the post-disbursement notification process. Contact person responsible for corrective action: Leah Alderink, Director of Student Financial Aid Anticipated Completion Date: Immediately
Airport Improvement Program, Infrastructure Investment and Jobs Act Programs, and COVID-19 Airport Programs; We recommend that the City implement a reporting system that requires all employees paid with federal funds to complete itemized, signed timesheets detailing the specific hours worked on each...
Airport Improvement Program, Infrastructure Investment and Jobs Act Programs, and COVID-19 Airport Programs; We recommend that the City implement a reporting system that requires all employees paid with federal funds to complete itemized, signed timesheets detailing the specific hours worked on each grant or project on a daily or weekly basis. These timesheets must be reviewed and approved by a supervisor with firsthand knowledge of the work performed.; Management's Response: The City of Red Bluff has used a log of time spent on the grant including date, description of activity, and time worked on the grant. The logs failed to account for non-grant related time as required by 2 CFR 200.430(g)(1)(iv).; Responsible Individual: Leanna Pearson, Assistant Finance Director; Corrective Action Plan: The City will set up separate tracking within the job category in the City’s payroll timekeeping software for grants. The employee will split the time in the timekeeping software and add notes describing the activities and grants worked on.; Anticipated Completion Date: 3-4-2026.
None reported. Finding: 2025-001 Inaccurate Resources Information Entry Name of Contact Person: Lynn Swett, Human Services Deputy Director Corrective Action: Proposed Completion Date: For the Year Ended June 30, 2025 Corrective Action Plan Section II. Financial Statement Findings Section III. Federa...
None reported. Finding: 2025-001 Inaccurate Resources Information Entry Name of Contact Person: Lynn Swett, Human Services Deputy Director Corrective Action: Proposed Completion Date: For the Year Ended June 30, 2025 Corrective Action Plan Section II. Financial Statement Findings Section III. Federal Award Findings and Questioned Costs Corrective Actions for Finding 2025-001 also apply to State Award Findings. Section IV - State Award Findings and Question Costs Staff were re-trained on effective date of change, and how to verify those dates are correct in NC FAST before the continuation of case processing, along with how to verify resources and the proper way to request information and what information is vital to case processing. Policy and procedures were used to ensure staff are trained appropriately. Second party reviews will continue to occur to ensure dates are correct in NC FAST, and second party reviews have increased to target 100% of all applications. The majority of cases found in error were in error prior to this training in December of 2024. Re-training occurs monthly during staff meetings to continue to improve outcomes. More difficult eligibility determination like those involving Special Needs Trust or Pooled Trust will be assigned to senior staff for processing and will immediately be second partied by the supervisor to ensure that resources and income are accounted for properly. Any noted discrepancies will be consulted with State Operation Support Team during processing of case. Second party reviews will continue to occur to ensure accuracy on information entered, including the use of resources. Trainings were completed by December 31, 2024, monthly staff meetings have been used to reinforce those training materials. 136
Finding 1179394 (2025-001)
Material Weakness 2025
None reported Name of Contact Person: Heather Owens - Medicaid Supervisor Corrective Action: Proposed Completion Date: Corrective actions for findings 2025-001 also apply to the State Awards findings. Section IV - State Award Findings and Questioned Costs All cases now undergo two separate superviso...
None reported Name of Contact Person: Heather Owens - Medicaid Supervisor Corrective Action: Proposed Completion Date: Corrective actions for findings 2025-001 also apply to the State Awards findings. Section IV - State Award Findings and Questioned Costs All cases now undergo two separate supervisory checks: One before the worker disposes of the case. A second check after disposal and worker sign-off to confirm that every identified correction was fully completed. This double-verification step was implemented immediately upon discovery of the issue. Each caseworker now receives a personalized checklist based on errors identified in their secondparty reviews. Workers must complete and submit this checklist at the time of review to acknowledge and address recurring issues. Immediate staff meetings were held to review audit findings and relevant policy. Additional training on correct income rules for recertifications is being developed (due to repeated findings). The supervisor has drafted the material, which will be submitted to State staff for review and approval. Training will be delivered to the entire team no later than the end of December 2025 (subject to State review timeline and holiday schedule). Weekly team meetings continue to cover Medicaid policy updates. Individual one-on-one meetings are held with each worker to review second-party errors, clarify policy, and provide coaching. A lead worker has been designated and is actively in training. The lead worker is already assisting with case staffing and troubleshooting while continuing to deepen her knowledge (particularly in the more complex Adult Medicaid program). Full lead-worker responsibilities are expected to be in place within the next six months. Second-party reviews now include checks of other active cases in the household or agency to ensure required changes are addressed and reported. This practice is reinforced with staff and monitored for compliance. The supervisor will complete a full review of pending COVID-related cases by the end of January 2026, followed by targeted team training on proper ongoing handling. All trainings and policy implementations will be completed by end of January 2026. Finding: 2025-001 Section III - Federal Award Findings and Questioned Costs Corrective Action Plan For Year Ended June 30, 2025 Section II - Financial Statement Findings 159
Action Plan - These errors were the result of a new student information system. As part of the implementation process, CIP codes were incorrectly migrated over from our legacy system to the new system (Colleague). This resulted in program enrollment status errors. Corrective Actions Completed: The R...
Action Plan - These errors were the result of a new student information system. As part of the implementation process, CIP codes were incorrectly migrated over from our legacy system to the new system (Colleague). This resulted in program enrollment status errors. Corrective Actions Completed: The Registrar's Office conducted a comprehensive review of all active program CIP codes and corrected all identified discrepancies within the student information system. The Registrar's Office is coordinating with Student Financial Services to verify that the 22 sampled students' enrollment and program statuses are accurately reflected in NSLDS. Corrective Actions in Progress: The Registrar's Office is obtaining direct NSLDS access to ensure the office responsible for enrollment reporting can independently review and validate reported data. Access is expected to be finalized by February 27th, 2026. Preventative Controls: Beginning Spring 2026, the Registrar's Office will implement a recurring end-of-term ntrol review. A sample of 12 students will be selected each semester to verify that enrollment status, program status, and CIP code reporting are accurate between the student information system and NSLDS. Results of this review will be documented and retained, and any discrepancies will be corrected prior to the subsequent enrollment submission. The Registrar believes these corrective measures address the root cause of the finding and strengthen internal controls to ensure ongoing compliance with federal reporting requirements. Responsible Official: Danielle Jeffress, University Registrar Estimated Completion Date: May 30, 2026
The College implemented additional procedures to allow earlier detection of fraud.
The College implemented additional procedures to allow earlier detection of fraud.
The College will perform the mass processing for COD reporting on a more frequent basis to ensure reporting is timely.
The College will perform the mass processing for COD reporting on a more frequent basis to ensure reporting is timely.
The Federal Programs Director, Paula Lovell, will ensure that all employees paid with Title I funds are assigned to eligible Title I positions. Paula Lovell will hold a monthly review meeting with the District Treasurer, Kathryn Powell, to review and monitor Title I expenditures and verify that all ...
The Federal Programs Director, Paula Lovell, will ensure that all employees paid with Title I funds are assigned to eligible Title I positions. Paula Lovell will hold a monthly review meeting with the District Treasurer, Kathryn Powell, to review and monitor Title I expenditures and verify that all salary and benefit payments charged to the program are appropriate.
Condition: During the compliance testing of the Uniform Guidance "Special Tests and Provisions - Sliding Fee Discounts" two (2) selections out of a sample size of forty (40) used the incorrect calculation of income from the proof of income and applied the incorrect sliding fee. Plan: Management will...
Condition: During the compliance testing of the Uniform Guidance "Special Tests and Provisions - Sliding Fee Discounts" two (2) selections out of a sample size of forty (40) used the incorrect calculation of income from the proof of income and applied the incorrect sliding fee. Plan: Management will ensure that all information is collected and input into the billing system correctly in order to avoid patients getting charged incorrect amounts for services. Anticipated Date of Completion: March 31, 2026. Name of Contact Person: Lori Sanson, CFO. Management's Response: Management is implementing weekly chart auditing of encounters from the prior week. These reviews will include a review of the client's financial information which includes assessment of the sliding fee scale paperwork completed, whether we have obtained proof of income, if the sliding fee was entered into the billing system, if the sliding fee adjustments are applied, if payment was collected, insurance information, and the client's balance. These audits will be sent to front office staff for corrections (if needed) or the CFO for review on a monthly basis. In addition, MCPHC Supervisors will obtain a monthly report of the clients that have not turned in proof of income in order to proactively reach out either by phone, email or mail and attempt to obtain the information.
PLANNED CORRECTIVE ACTION - The Davis-Bacon Act requirements to submit weekly payroll certification will be included in all contract language for federally funded projects as well as on our purchase orders. The finance department will continued to follow up with vendors to ensure payroll certificati...
PLANNED CORRECTIVE ACTION - The Davis-Bacon Act requirements to submit weekly payroll certification will be included in all contract language for federally funded projects as well as on our purchase orders. The finance department will continued to follow up with vendors to ensure payroll certifications are collected before invoice payments are made. ANTICIPATED COMPLETION DATE - February 13, 2026 RESPONSIBLE CONTACT PERSON - Shannon Rodriguez, CFO
FINDING 2025-005 Finding Subject: COVID-19 - Education Stabilization Fund - Reporting Contact Person Responsible for Corrective Action: Lana Hamilton Contact Phone Number and Email Address: 812-883-4437, ext. 1005, lhamilton@salemschools.us Views of Responsible Officials: We concur with the finding ...
FINDING 2025-005 Finding Subject: COVID-19 - Education Stabilization Fund - Reporting Contact Person Responsible for Corrective Action: Lana Hamilton Contact Phone Number and Email Address: 812-883-4437, ext. 1005, lhamilton@salemschools.us Views of Responsible Officials: We concur with the finding Description of Corrective Action Plan: Internal controls for reimbursement requests will include necessary documentation of expenditures from the accounting program attached to the reimbursement form for all grants. Each reimbursement request will be checked and approved by two school employees. The treasurer will keep the packet until funds are received and receipted and then the packet, with the receipt, will be filed in two places; the respective grant folder and in the monthly receipt folder. Anticipated Completion Date: 2/16/2026
Need Analysis Planned Corrective Action: System-generated notifications have been implemented within our student information system to flag any academic year changes or required reviews. In addition, a periodic review process of student award packages has been established to ensure funds are awarded...
Need Analysis Planned Corrective Action: System-generated notifications have been implemented within our student information system to flag any academic year changes or required reviews. In addition, a periodic review process of student award packages has been established to ensure funds are awarded accurately and in accordance with applicable awards. Person Responsible for Corrective Action Plan: Giselle Atenco, Director of Financial Aid Anticipated Date of Completion: Already Implemented
Views of Responsible Officials and Planned Corrective Actions: Management agrees with the finding. As of the date of the audit report, the math coach has renewed and obtained an active State of Florida teaching certification. Management has implemented procedures to monitor certification expiration ...
Views of Responsible Officials and Planned Corrective Actions: Management agrees with the finding. As of the date of the audit report, the math coach has renewed and obtained an active State of Florida teaching certification. Management has implemented procedures to monitor certification expiration dates and verify certification status prior to charging payroll costs to Title I and other federally funded programs.
Views of Responsible Officials and Planned Corrective Actions – While the Financial Aid Office does have two personnel reviewing each R2T4 calculation, the same was not done with the online calendars setup in COD. The Director will now review each online calendar before they are utilized. The Office...
Views of Responsible Officials and Planned Corrective Actions – While the Financial Aid Office does have two personnel reviewing each R2T4 calculation, the same was not done with the online calendars setup in COD. The Director will now review each online calendar before they are utilized. The Office of Financial Aid performed a review of the population of 672 students, noting an incorrect amount of funds was returned to the Department of Education for 32 of those students. The College has corrected and sent back the additional funds that the students were not eligible to receive.
Grant Accounting Finding 2025-006 Federal Agency Name: Department of Housing and Urban Development Assistance Listing Number: 14.267 Program Name: Continuum of Care Finding Summary: Catholic Charities did not have adequate internal controls in place to ensure that the administrative costs were appro...
Grant Accounting Finding 2025-006 Federal Agency Name: Department of Housing and Urban Development Assistance Listing Number: 14.267 Program Name: Continuum of Care Finding Summary: Catholic Charities did not have adequate internal controls in place to ensure that the administrative costs were appropriately billed as allowed under uniform guidance. Corrective Action Plan: CCSPM will adhere to uniform guidance specific to Administrative Expenses ensuring Administrative Expenses plus Indirect Expenses are no more than 10% of the total award over the grant period. Adherence will be monitored as part of an expanded monthly secondary review process across Continuum of Care grants. Responsible Individuals: Mary Ammer, Senior Director of Accounting and Finance and Grant Accountants: Jen Goeppinger and Ashley Feldick. Anticipated Completion Date: Adherence will be met by the end of the current grant period or end of FY26 (6.30.26), whichever is sooner for each currently active Continuum of Care grant.
Finding 2025-002 Federal Agency Name: Department of Housing and Urban Development Assistance Listing Number: 14.267 Program Name: Continuum of Care Finding Summary: Catholic Charities’ internal controls did not operate as designed, which resulted in rent reasonableness tests not being reviewed befor...
Finding 2025-002 Federal Agency Name: Department of Housing and Urban Development Assistance Listing Number: 14.267 Program Name: Continuum of Care Finding Summary: Catholic Charities’ internal controls did not operate as designed, which resulted in rent reasonableness tests not being reviewed before the rent was paid. Corrective Action Plan: The Senior Division Director (now VP of Housing) issued the Rent Reasonableness Policy (Scattered Sites) on May 14, 2025. This policy was approved by the CEO on June 3, 2025, and was disseminated to all applicable staff via the Learning Management System (Bridge). Staff are required to read and electronically sign acknowledgement of every policy sent to them via Bridge. Managers in the Scattered Site program were trained on the policy and procedure in July 2025. To ensure compliance with this policy, the VP of Housing will audit all client files at least twice annually. The first audit is scheduled for March 11, 2026. Results of the internal audit will be shared with the Compliance Department for further assessment and action. Responsible Individuals: Kristen Brown, Vice-President of Housing Anticipated Completion Date: March 31, 2026
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