Corrective Action Plans

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Finding 554612 (2024-018)
Significant Deficiency 2024
2024-018 Oregon Department of Human Services Strengthen Medicaid fraud hotline reporting mechanismsManagement Response: We agree with this recommendation and will work to develop a more effective public facing referral process.. Anticipated Completion Date: July 31, 2026 Contact person: Jennifer Sta...
2024-018 Oregon Department of Human Services Strengthen Medicaid fraud hotline reporting mechanismsManagement Response: We agree with this recommendation and will work to develop a more effective public facing referral process.. Anticipated Completion Date: July 31, 2026 Contact person: Jennifer Stallsworth, Chief of Staff, ODHS APD, April Gillette, OHA Medicaid Division, Strategic Operations & Improvement Director
Finding 554598 (2024-010)
Significant Deficiency 2024
2024-010 Oregon Health Authority Submit required Federal Funding Accountability and Transparency Act reports Management Response: The agency agrees with the finding. The FFATA Reporting Coordinator position within the Office of Contracts & Procurement (OC&P) has been vacant for eight months but sho...
2024-010 Oregon Health Authority Submit required Federal Funding Accountability and Transparency Act reports Management Response: The agency agrees with the finding. The FFATA Reporting Coordinator position within the Office of Contracts & Procurement (OC&P) has been vacant for eight months but should be filled by April 15, 2025. On March 8, 2025, FSRS.gov was retired, and all subaward reporting data and functionality are now on SAM.gov. The new SAM.gov reporting system will allow for multiple Data Entry roles, allowing each program or division of ODHS/OHA to submit their own reporting, and allowing OC&P to conduct Quality Assurance/Quality Control. Once the FFATA Reporting Coordinator is onboard and trained, we anticipate the FFATA reporting will resume and any missing reports will be submitted by April 15, 2026. Anticipated Completion Date: April 15, 2026 Contact person: Noemi Schlegel, Compliance & Audits Program Manager
Finding 554596 (2024-033)
Significant Deficiency 2024
2024-033 Oregon Housing and Community Services Department Federal reports should contain accurate information Management Response: The agency agrees with this finding. A dedicated staff resource has been trained and has brought grant reconciliations and reporting current. Additional training has bee...
2024-033 Oregon Housing and Community Services Department Federal reports should contain accurate information Management Response: The agency agrees with this finding. A dedicated staff resource has been trained and has brought grant reconciliations and reporting current. Additional training has been provided for awareness of the obligation requirements as well. Anticipated Completion Date: June 30, 2025 Contact person: Beth Brown, Controller
Finding 554589 (2024-021)
Significant Deficiency 2024
2024-021 Oregon Department of Human Services Obtain accurate information from the ONE application Management Response: We agree with this recommendation. ODHS will continue to monitor and review the ACF-199 and ACF-209 prior to submission. The review will include a sample of JOBS eligible individual...
2024-021 Oregon Department of Human Services Obtain accurate information from the ONE application Management Response: We agree with this recommendation. ODHS will continue to monitor and review the ACF-199 and ACF-209 prior to submission. The review will include a sample of JOBS eligible individuals who do not have countable work activities in the ACF reports, to confirm that their TRACS personal development plan (PDP) accurately reflects engagement and activities in which the individual is engaged. Additionally, ODHS will implement a tracking system to ensure the review of reports is clearly documented. ODHS will continue to work with our vendor to secure a SOC 2 Type II audit of our processes and oversight of the ONE system in 2025. Additionally, ODHS will work on amending the ONE Maintenance & Operations agreement with Deloitte for them to obtain a scoped SOC 2 Type II audit related to their work within the ONE system. ODHS would expect to negotiate this additional audit requirement in 2025 with the first audit then happening in 2026. Anticipated Completion Date: December 31, 2025 Contact Person: Eva Ruiz, TANF program manager
Finding 554587 (2024-029)
Significant Deficiency 2024
2024-029 Oregon Commission for the Blind Strengthen internal controls to ensure performance data reports are accurate Management Response: We agree with the recommendation. The agency is committed to ensuring the RSA-911 client case information report is accurate, and to ensuring the agency’s case m...
2024-029 Oregon Commission for the Blind Strengthen internal controls to ensure performance data reports are accurate Management Response: We agree with the recommendation. The agency is committed to ensuring the RSA-911 client case information report is accurate, and to ensuring the agency’s case management system is well-documented and current. This issue was initially identified during the statewide single audit for the period ended June 30, 2023. In response to the prior year’s finding, the agency created a new case-note category for documenting client employment start date and wages at exit. Compliance with this new control is then verified as part of our pre-closure case file review process. The agency will continue to provide training to staff on the use of this case note category to ensure we are consistently documenting the start date of employment in the primary occupation and the hourly wage at exit. Anticipated Completion Date: July 1, 2025 Contact person: Angel Hale, Director of Vocational Rehabilitation Services
Finding 554586 (2024-028)
Significant Deficiency 2024
2024-028 Oregon Department of Human Services Strengthen internal controls to ensure performance data reports are accurate Management Response: We agree with this recommendation. We agree with the recommendation and will ensure adequate supporting documentation is maintained and readily available to ...
2024-028 Oregon Department of Human Services Strengthen internal controls to ensure performance data reports are accurate Management Response: We agree with this recommendation. We agree with the recommendation and will ensure adequate supporting documentation is maintained and readily available to support information reported in the RSA-911. We will update internal controls related to this matter. Anticipated Completion Date: September 30, 2024 Contact Person: Bryan Campbell, Vocational Rehabilitation Operations Manager
Finding 554584 (2024-038)
Significant Deficiency 2024
2024-038 Oregon Business Development Department Implement controls over reporting Management Response: We agree with this recommendation. The submission of the quarterly financial reports by Business Oregon to DAS CFRT is on-going and within the submission deadline of DAS CFRT staff. When preparing ...
2024-038 Oregon Business Development Department Implement controls over reporting Management Response: We agree with this recommendation. The submission of the quarterly financial reports by Business Oregon to DAS CFRT is on-going and within the submission deadline of DAS CFRT staff. When preparing for the quarterly financial report, the accounting/financial data has been prepared by our accountant and reviewed by Business Oregon’s accounting manager. The data is then submitted to program staff to complete the programmatic narrative and other performance-related information to further explain or describe the transactions for the reporting period, and then program staff submits the quarterly report to DAS CFRT. Going forward, to ensure reports submitted to DAS CFRT match with accounting records, management will make procedure changes by routing the report back to the accounting team for final review of financial data after program has entered their part of the report before sending to DAS CFRT. We will implement this process change effective immediately for the quarterly report ending March 2025. For the cumulative variance of $1.6 million, Business Oregon will conduct research to determine the cause of the variance. The under-reporting of expenses on the quarterly report ending June 2024 could be the result of data provided to DAS in mid-July 2024, to meet DAS CFRT reporting deadline, when the fiscal month of June 2024 was not officially closed until early August 2024. While the fiscal year-end process was still on-going through August 2024, the month of June is still open for accrual entries or adjustments, resulting to more expenditures in accounting records than what was reported to DAS in July. Business Oregon will perform reconciliation of data from 2020 to March 2025 to true up the expenditures reported in the accounting records and the reports submitted to DAS CFRT. Anticipated Completion Date: March 31, 2025 Contact person: Imee Anderson, Chief Financial Officer, Mia Seo, Deputy-Chief Financial Officer, Rory Spencer, Accounting Manager
Finding 554580 (2024-034)
Significant Deficiency 2024
2024-034 Oregon Housing and Community Services Department Quarterly Performance Report should include all expenditures incurred to date Management Response: The agency agrees with this finding. Quarterly performance report requirements will be reviewed with staff and additional oversight will be add...
2024-034 Oregon Housing and Community Services Department Quarterly Performance Report should include all expenditures incurred to date Management Response: The agency agrees with this finding. Quarterly performance report requirements will be reviewed with staff and additional oversight will be added to ensure accurate reporting occurs. Corrective reports will be filed to the extent allowed by HUD. Anticipated Completion Date: June 30, 2025 Contact person: Beth Brown, Controller
Finding 554579 (2024-036)
Significant Deficiency 2024
2024-036 Oregon Business Development Department Implement controls and submit delinquent FFATA reports Management Response: We partially agree with this recommendation. Business Oregon has prepared and submitted FFATA reports in SAM.gov through 2023, and had done so yearly since 2011. Due to staff t...
2024-036 Oregon Business Development Department Implement controls and submit delinquent FFATA reports Management Response: We partially agree with this recommendation. Business Oregon has prepared and submitted FFATA reports in SAM.gov through 2023, and had done so yearly since 2011. Due to staff turnover, Business Oregon has not completed loading the data for FFATA reporting for 2024. Business Oregon is currently in the process of compiling the data pertaining to CDBG grant awards and other federal grant awards that met the criteria for FFATA reporting. Business Oregon will formally assign this reporting task and create written procedures regarding preparation of the FFATA reports to ensure a complete list of recipients or subawards is reported in SAM.gov in a timely manner. The estimated completion date of this corrective action is 6/30/2025. Anticipated Completion Date: June 30, 2025 Contact person: Imee Anderson, Chief Financial Officer, Mia Seo, Deputy-Chief Financial Officer, Rory Spencer, Accounting Manager, Jon Unger, CDBG Program Manager
Finding 554578 (2024-035)
Significant Deficiency 2024
2024-035 Oregon Business Development Department Ensure CDBG expenditures are recorded in SFMA under the appropriate grant year Management Response: We agree with this recommendation. In February of 2025, the agency’s accountant assigned to this program began a full reconciliation of the CDBG program...
2024-035 Oregon Business Development Department Ensure CDBG expenditures are recorded in SFMA under the appropriate grant year Management Response: We agree with this recommendation. In February of 2025, the agency’s accountant assigned to this program began a full reconciliation of the CDBG program from FY 2020 to FY 2024. We have identified the differences between our accounting records in SFMA and what has been recorded through IDIS, our portal to request funds from the federal government. As of March 2025, we are beginning to finalize our reconciliation of administrative funds and our own agency’s matching contributions. Once incorporating this first step, our accounting staff will continue with a full project reconciliation for the current fiscal year, 2025. Any errors or adjustments identified will be corrected in this current fiscal year. This reconciliation between accounting records in SFMA and IDIS is expected to be complete in May of 2025. Anticipated Completion Date: May 31, 2025 Contact person: Imee Anderson, Chief Financial Officer, Mia Seo, Deputy-Chief Financial Officer, Rory Spencer, Accounting Manager, Jon Unger, CDBG Program Manager
Finding 554577 (2024-042)
Significant Deficiency 2024
2024-042 Oregon Military Department Ensure payroll expenditures are coded to the correct period and errors are corrected timely Management Response: We agree with this recommendation. OMD acknowledges the finding regarding payroll expenditures coded outside the period of performance. We are committe...
2024-042 Oregon Military Department Ensure payroll expenditures are coded to the correct period and errors are corrected timely Management Response: We agree with this recommendation. OMD acknowledges the finding regarding payroll expenditures coded outside the period of performance. We are committed to strengthening controls to ensure payroll expenses are properly recorded and errors are promptly corrected. OMD will implement following corrective actions to address the recommendation made in the Audit Report. • All Payroll Coding Review Procedures: Establish a mandatory review process before finalizing payroll reimbursement requests to verify the correct coding of federal fiscal year allocations. • Timely Error Correction Process: Develop a formal procedure to ensure errors are identified and corrected within 60-90 days of discovery. • Training and Oversight: Conduct mandatory training for finance and payroll personnel on proper coding procedures and compliance with federal performance periods. • Review and Correction of Prior Year Coding Errors (FFY 2019, 2022, and 2023): Conduct a comprehensive review of payroll expenditures from FFY 2019, 2022, and 2023 to identify and correct any remaining errors. This process will involve reconciling payroll records with federal grant periods, adjusting accounting records, and ensuring proper documentation for any necessary retroactive corrections. Anticipated completion date: January 31, 2026. Contact person: Adam Giblin, Chief Financial Officer.
View Audit 353285 Questioned Costs: $1
Finding 554575 (2024-031)
Significant Deficiency 2024
2024-031 Department of Education Implement controls to ensure FFATA reporting is completed for all required subawards Management Response: ODE agrees with this finding. To strengthen controls and ensure FFATA reporting is completed for all required subawards, ODE plans to implement the following pro...
2024-031 Department of Education Implement controls to ensure FFATA reporting is completed for all required subawards Management Response: ODE agrees with this finding. To strengthen controls and ensure FFATA reporting is completed for all required subawards, ODE plans to implement the following process improvements: • Collaborate with the Child Nutrition program management and Fiscal Grants team to provide full documentation of grant awards including terms, conditions and attachments. • Update ODE’s grant profile request Smartsheet tool to: o Identify FFATA eligibility prior to setting up a new grant award in the accounting system. o Automatically notify the FFATA team of new grant awards that require reporting. Anticipated Completion Date: June 30, 2025 Contact person: Kristie Miller, Accounting Director
The Organization will enhance its procedures and internal controls with respect to preparation and requests of funds. Grant agreements will be reviewed to confirm if expenditures being requested are allowed. The Organization will add a secondary level of review to ensure reimbursement requests are a...
The Organization will enhance its procedures and internal controls with respect to preparation and requests of funds. Grant agreements will be reviewed to confirm if expenditures being requested are allowed. The Organization will add a secondary level of review to ensure reimbursement requests are accurately stated.
View Audit 353273 Questioned Costs: $1
The Organization will enhance its procedures and internal controls with respect to preparation and requests of funds. Grant agreements will be reviewed to confirm if expenditures being requested are allowed. The Organization will add a secondary level of review to ensure reimbursement requests are a...
The Organization will enhance its procedures and internal controls with respect to preparation and requests of funds. Grant agreements will be reviewed to confirm if expenditures being requested are allowed. The Organization will add a secondary level of review to ensure reimbursement requests are accurately stated.
View Audit 353273 Questioned Costs: $1
Regarding 2024-1, we recognize that our current finance department is not adequately staffed with the caliber of accountants needed to support an organization of our size and complexity. Management and the Board are currently assessing our needs and weighing options regarding restructuring our finan...
Regarding 2024-1, we recognize that our current finance department is not adequately staffed with the caliber of accountants needed to support an organization of our size and complexity. Management and the Board are currently assessing our needs and weighing options regarding restructuring our finance department. Regardless of structure and staffing, moving forward, Management will develop and implement more efficient and effective processes for proper posting and regular reconciliation of grant-related balances to the accounting software and ongoing scrutiny of those processes.
2024-005 - REPORTING Significant Deficiency Auditee’s Response and Planned Corrective Action FHA is implementing a Capital Fund close out checklist quarterly review process. The Executive Director and accounting team will participate in additional capital funding courses to improve its knowledge and...
2024-005 - REPORTING Significant Deficiency Auditee’s Response and Planned Corrective Action FHA is implementing a Capital Fund close out checklist quarterly review process. The Executive Director and accounting team will participate in additional capital funding courses to improve its knowledge and practices of required submission deadlines and government policy changes, if any. The new Fiscal Officer is tasked with monitoring submission deadlines via HUD’s EPIC and eLOCCS platforms. Planned Implementation Date of Corrective Action: Immediate Person Responsible for Corrective Action: Bobbi Richards, Executive Director
2024-004 - REPORTING Significant Deficiency Auditee’s Response and Planned Corrective Action As with 2024-001, this finding was based on a HUD system error that prevented submission on the due date. FHA experienced transition in the fiscal department and is cross-training backup personnel. A 10-day ...
2024-004 - REPORTING Significant Deficiency Auditee’s Response and Planned Corrective Action As with 2024-001, this finding was based on a HUD system error that prevented submission on the due date. FHA experienced transition in the fiscal department and is cross-training backup personnel. A 10-day buffer will be applied internally to submission deadlines to ensure on-time filing regardless of staff changes and absences. Planned Implementation Date of Corrective Action: Immediate Person Responsible for Corrective Action: Bobbi Richards, Executive Director
Procedures will be added to ensure proper reporting in future periods.
Procedures will be added to ensure proper reporting in future periods.
FINDING 2024-003: Head Start Program Control Weakness of Filing the Required Semi-Annual and Annual Reports ...
FINDING 2024-003: Head Start Program Control Weakness of Filing the Required Semi-Annual and Annual Reports Response: The District Clerk will contact the Head Start Grant Specialist to ensure the SF424 semi and annual reports are reviewed and approved when submitted. The District should implement a policies and procedures requiring that all Head Start reports be submitted within 30 days of the reporting period end date.
Finding 554500 (2024-001)
Significant Deficiency 2024
The City internally identify improvement opportunities in managing grants. As a part of the City’s grant oversight improvement efforts, the City began implementing various processes and internal controls surrounding grant monitoring, which improves the SEFA drafting process and mitigates risks of f...
The City internally identify improvement opportunities in managing grants. As a part of the City’s grant oversight improvement efforts, the City began implementing various processes and internal controls surrounding grant monitoring, which improves the SEFA drafting process and mitigates risks of future inaccuracies. These efforts began in early 2024 and include the following: • Creation of a grant policy that provides City staff with guidance, information, and expectations surrounding grants. • Creation of a master grants database that lists the general ledger fund, applicable project ledger references, status, grant type, start/end dates, granting agency, pass-through agency, grant name, assistance listing numbers, grant amounts, and the grant manager for each grant. This database is now used to verify the completeness and accuracy of the SEFA (beginning FY24). • Formal quarterly monitoring. Each quarter, the City will formally review the grants database with department contacts and grant managers to verify the completeness and accuracy of the database. The City is formalizing this process and plans to include department signoffs evidencing the review process. If any items are missing, the missing component will be identified and added to the database on a timely basis. The City will also utilize this quarterly process to review the grants policy to ensure grant managers are aware of the requirements related to their grants. • The City is in the process of formalizing the SEFA drafting process utilized during the FY24 SEFA preparation, which includes additional mitigating procedures such as reviewing all next FY federal receipts to ensure none of them relate to the SEFA year federal expenditures. Personnel Responsible for Implementation: Marvin Lopez Position of Responsible Personnel: Deputy Administrative Services Director (Fiscal Services) Expected Date of Implementation: June 30, 2025
Views of Responsible Officials: To ensure compliance moving forward, the Center, as a direct recipient, will identify all Federal grants where they have a subaward reporting recipient, along with their reporting timelines and deadlines. The Center has likewise identified the staff owner of FFATA rep...
Views of Responsible Officials: To ensure compliance moving forward, the Center, as a direct recipient, will identify all Federal grants where they have a subaward reporting recipient, along with their reporting timelines and deadlines. The Center has likewise identified the staff owner of FFATA reporting within the Center. Immediately after the finding during the audit, the Center has prepared the subsequent year’s FFATA report to ensure compliance in subsequent fiscal year, 2025.
Condition: Northeastern Illinois University (University) did not have adequate procedures in place to ensure the Education Stabilization Fund – Higher Education Emergency Relief Fund (HEERF) reports were accurate and timely submitted to the U.S. Department of Education and posted to NEIU’s website. ...
Condition: Northeastern Illinois University (University) did not have adequate procedures in place to ensure the Education Stabilization Fund – Higher Education Emergency Relief Fund (HEERF) reports were accurate and timely submitted to the U.S. Department of Education and posted to NEIU’s website. Planned Corrective Action: The grants and Contracts Office will frequently review funding agency websites to ensure reports are up to date with changes in reporting requirements. The published reports will be revised to meet the requirements of the funding agency. The Grants and Contracts Office will also ensure that reports will be submitted and published as required by the funding agency in a timely manner. Contact person responsible for corrective action: Jannica Rae Quintana, Director of Controller’s office and Ruthann Griffith, Grants and Contracts Manager Anticipated Completion Date: 1/30/2025
Condition: Northeastern Illinois University (University) did not have adequate procedures and controls in place to ensure student that unofficially withdrew during the semester were accurately reported to the National Student Loan Data System (NSLDS) for the effective date of the enrollment change P...
Condition: Northeastern Illinois University (University) did not have adequate procedures and controls in place to ensure student that unofficially withdrew during the semester were accurately reported to the National Student Loan Data System (NSLDS) for the effective date of the enrollment change Planned Corrective Action: Registrar’s office will utilize the financial aid’s last date of attendance report to back date the effective enrollment reported date for unofficially withdrawn students. Contact person responsible for corrective action: Rahshida Walker, Registrar Anticipated Completion Date: 6/30/2025
Finding 554416 (2024-003)
Significant Deficiency 2024
Recommendation: We recommend that the City adhere to the Compliance and Reporting Guidance for the SLFRF program and establish internal controls to ensure the City submits required reports when they are due. Views of Responsible Officials: The City has changed the process to submit their Quarterly r...
Recommendation: We recommend that the City adhere to the Compliance and Reporting Guidance for the SLFRF program and establish internal controls to ensure the City submits required reports when they are due. Views of Responsible Officials: The City has changed the process to submit their Quarterly reports. Reports are reviewed by the Grants Administration Department and Finance Department before they are submitted. The Finance Department has implemented procedures to ensure that all reports are processed and submitted timely. Proposed Completion Date: Fiscal Year 2024-2025 Contact Person: Ascencion Alonzo, Director of Finance, City of Edinburg
Aging Cluster – Assistance Listing Numbers: 93.044, 93.045, and 93.053 Recommendation: We recommend the Agency implement an internal control to have a documented review of the reports by a person independent of the preparer of the report Explanation of disagreement with audit finding: There is no di...
Aging Cluster – Assistance Listing Numbers: 93.044, 93.045, and 93.053 Recommendation: We recommend the Agency implement an internal control to have a documented review of the reports by a person independent of the preparer of the report Explanation of disagreement with audit finding: There is no disagreement with the finding. Action taken in response to finding: The Agency will review its processes to ensure an internal control is implemented. Name of the contact person responsible for corrective action: Tony Vermazen, Fiscal Manager Planned completion date for corrective action plan: Fiscal Year 2025
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