Corrective Action Plans

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2022-003 – Untimely Submission of Claim Amendments for Reimbursement Corrective Action – This is a repeat finding, and improvements have been made since the release of the December 31, 2022, audit. In addition to retraining staff to enhance the accuracy of meal counts, GYAC has purchased an electron...
2022-003 – Untimely Submission of Claim Amendments for Reimbursement Corrective Action – This is a repeat finding, and improvements have been made since the release of the December 31, 2022, audit. In addition to retraining staff to enhance the accuracy of meal counts, GYAC has purchased an electronic system (KID KARE) to assist with tracking both meal count sheets and attendance rosters. This system ensures that meal counts and attendance rosters are reconciled, reducing the error rate in submissions. The system also checks for errors prior to claim submission and compares names on the roll with the number of meals being claimed for accuracy.
2023-002 – Reimbursement Claims Not Supported by Meal Count Sheets Corrective Action – This is a repeat finding and improvements have been made since the release of the December 31, 2022, audit. In addition to retraining staff to enhance the accuracy of meal counts, GYAC has purchased an electronic ...
2023-002 – Reimbursement Claims Not Supported by Meal Count Sheets Corrective Action – This is a repeat finding and improvements have been made since the release of the December 31, 2022, audit. In addition to retraining staff to enhance the accuracy of meal counts, GYAC has purchased an electronic system (KID KARE) to assist with tracking both meal count sheets and attendance rosters. This system ensures that meal counts and attendance rosters are reconciled, reducing the error rate in submissions. The system also checks for errors prior to claim submission and compares names on the roll with the number of meals being claimed for accuracy.
2023-003 Clients Not Billed in Accordance with the Housing Owner’s Certification and Application for Housing Assistance Payments Recommendation: We recommend that accounting staff responsible for client billing is provided sufficient training and oversight. Additionally, we recommend that monthly ...
2023-003 Clients Not Billed in Accordance with the Housing Owner’s Certification and Application for Housing Assistance Payments Recommendation: We recommend that accounting staff responsible for client billing is provided sufficient training and oversight. Additionally, we recommend that monthly billing of client rent is reviewed and reconciled in accordance with the Housing Owner’s Certification and Application for Housing Assistance Payments. Auditee Response: We concur with the finding and have begun implementing the recommendations.
2023-003 Clients Not Billed in Accordance with the Housing Owner’s Certification and Application for Housing Assistance Payments Recommendation: We recommend that accounting staff responsible for client billing is provided sufficient training and oversight. Additionally, we recommend that monthly ...
2023-003 Clients Not Billed in Accordance with the Housing Owner’s Certification and Application for Housing Assistance Payments Recommendation: We recommend that accounting staff responsible for client billing is provided sufficient training and oversight. Additionally, we recommend that monthly billing of client rent is reviewed and reconciled in accordance with the Housing Owner’s Certification and Application for Housing Assistance Payments. Auditee Response: We concur with the finding and have begun implementing the recommendations.
U.S. Department of Health and Human Services Washington County Memorial Hospital (“Hospital”) respectfully submits the following corrective action plan for the year ended August 31, 2023. Audit period: September 1, 2022 – August 31, 2023 The findings from the schedule of findings and questioned cos...
U.S. Department of Health and Human Services Washington County Memorial Hospital (“Hospital”) respectfully submits the following corrective action plan for the year ended August 31, 2023. Audit period: September 1, 2022 – August 31, 2023 The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS— FINDINGS AND QUESTIONED COSTS – MAJOR FEDERAL PROGRAMS DEPARTMENT OF HEALTH AND HUMAN SERVICES 2023 – 001 COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution Recommendation: We recommend the Hospital design controls to ensure that reporting is completing in accordance with latest HHS guidelines. Action taken in response to finding: The Hospital will ensure that they use the appropriate method of reporting lost revenue calculations in the future reporting periods. Name of the contact person responsible for corrective action: Debra Pratt, CFO. Planned completion date for corrective action plan: September 1, 2024 If the Department of Health and Human Services has questions regarding this plan, please call Debra Pratt, CFO at (573) 438 5451 Ext 771.
Finding 400882 (2023-001)
Significant Deficiency 2023
The City agrees with the finding. The City will improve internal controls over the Performance and Expenditure report review process and ensure this review addresses all aspects of the reports and is completed prior to submission. Corrective action was taken in spring of 2024 when the issue was iden...
The City agrees with the finding. The City will improve internal controls over the Performance and Expenditure report review process and ensure this review addresses all aspects of the reports and is completed prior to submission. Corrective action was taken in spring of 2024 when the issue was identified during the 2023 audit. Responsible Official: Catrina Asher, Finance Director Planned completion date for corrective action plan: March 31, 2024.
Federal Program: ALN 93.959 Block Grants for Prevention and Treatment of Substance Abuse (Prevention, COVID-19 Prevention II, COVID-19 Treatment, and COVID-19 ARPA Prevention) Condition: During testing of contracts with subrecipients it was noted that these contracts did not include portions of requ...
Federal Program: ALN 93.959 Block Grants for Prevention and Treatment of Substance Abuse (Prevention, COVID-19 Prevention II, COVID-19 Treatment, and COVID-19 ARPA Prevention) Condition: During testing of contracts with subrecipients it was noted that these contracts did not include portions of required disclosures. Corrective Action Plan: The NMRE will include the information in contracts with subrecipients that are required in 2 CFR 200.332. Responsible Party: Provider Network Manager Date of anticipated implementation: FY24 going forward Thank you Regards, Deanna Yockey, CFO Northern Michigan Regional Entity 1999 Walden Drive Gaylord, MI 49770 231-383-6438
Planned Corrective Action: ARPA Grant Funds are now being approved by the Controller before submitting to the Treasury Website. Responsible officials: Luis Barrera, Controller, will be responsible for approvals before submitting the expenditures Planned completion date: The approval process was impl...
Planned Corrective Action: ARPA Grant Funds are now being approved by the Controller before submitting to the Treasury Website. Responsible officials: Luis Barrera, Controller, will be responsible for approvals before submitting the expenditures Planned completion date: The approval process was implemented on October 31, 2023
Finding: 2023-003 Lack of Depository Agreement – Special Provisions Federal agency: U.S. Department of Housing and Urban Development Federal program Title: Housing Choice Voucher Program Assistance Listing Number: 14.871 and 14.879 Federal Award Identification Number and Year: N/A Pass-Through Agen...
Finding: 2023-003 Lack of Depository Agreement – Special Provisions Federal agency: U.S. Department of Housing and Urban Development Federal program Title: Housing Choice Voucher Program Assistance Listing Number: 14.871 and 14.879 Federal Award Identification Number and Year: N/A Pass-Through Agency: N/A Pass-Through Number(s): N/A Award Period: December 31, 2023 Type of Finding: Material Weakness in Internal Control Over Compliance and Other Matters Recommendation: We recommend the HRA enter into this agreement into place as soon as possible. Views of Responsible Officials: There is no disagreement with the audit finding. Action Taken in Response to Finding: The HRA will get a depository agreement in place. Name of the Contact Person Responsible for Corrective Action Plan: Rhonda Moen, Finance Manager Planned Completion Date for Corrective Action Plan: December 31, 2024.
Finding 400835 (2023-006)
Significant Deficiency 2023
Company-wide reports are submitted monthly to the Board of Directors for approval. Reports that are submitted are separated by grant, so that the Board of Directors can see the activity in each grant for each month during the fiscal year. The reports submitted to the funders by Marlon Mitchell are t...
Company-wide reports are submitted monthly to the Board of Directors for approval. Reports that are submitted are separated by grant, so that the Board of Directors can see the activity in each grant for each month during the fiscal year. The reports submitted to the funders by Marlon Mitchell are taken from the financial reports that are approved by the Board of Directors. In addition, Marlon does not enter the financial information, nor does he prepare the monthly reports submitted to the Board. He serves as a fourth set of eyes on the information before the reports are submitted to the funders. Khayriyah Mitchell enters all of the revenue and expenditures into the accounting system, Shanelle Herman reconciles the bank and credit card accounts and runs the reports for the Board of Directors, the Board reviews and approves the financial statements, and Marlon Mitchell uses the approved financial information to create the reports to the grant funding agencies.
Management acknowledges the delay in completing the FYE 2023 audit and filing the Data Collection Form (SF-SAC) on time. We have since completed the audit and submitted the required documentation to the Federal Audit Clearinghouse. To prevent recurrence of this issue the following corrective actio...
Management acknowledges the delay in completing the FYE 2023 audit and filing the Data Collection Form (SF-SAC) on time. We have since completed the audit and submitted the required documentation to the Federal Audit Clearinghouse. To prevent recurrence of this issue the following corrective actions will be implemented: -Establish a detailed timeline for the audit process, including key milestones and deadlines -Conduct regular progress review to ensure adherence to the timeline -Allocate additional resources to the finance departments as needed during critical periods to ensure timely completion of tasks -Improve communication between the audit team and mangement to promptly address any issues that may cause delays. Responsible Party: Ed Gonzalez, CFO, will be responsible for overseeing the implementation and execution of this corrective action plan. Estimated Completion Date: The corrective actions outlined above are expected to be fully implemented by May 31, 2024. We are committed to ensuring compliance with all financial reporting obligations and will take the necessary steps to prevent future occurrences of such delays.
Finding 2023-001: Allowable costs – significant deficiency in internal controls over compliance and compliance finding. Management Response CCGD was issued monitoring findings by HHSC for the monitoring period October 2021 (FY 21) -November 2022 (FY 22) in April 2023. As a result of that finding, CC...
Finding 2023-001: Allowable costs – significant deficiency in internal controls over compliance and compliance finding. Management Response CCGD was issued monitoring findings by HHSC for the monitoring period October 2021 (FY 21) -November 2022 (FY 22) in April 2023. As a result of that finding, CCGD received a finding in its 2022 audit. Because of the timing of the findings, as noted in the 2023 audit report, there was not time to resolve the issue before 2023. Therefore, even though the below described plan was implemented in 2023, immediately upon receipt of the initial finding, CCGD was still issued a finding in its FY2023 audit. The notification was received in the 7th month of fiscal year 2023, the following plan has been implemented. o Timesheet and GL mismatch i. Management Response: 1. Perform an audit of existing setup of HRIS-Paycom system to determinecause of mismatch 2. If needed, reimplement Paycom with required setup or change vendors 3. All departments along with respective service categories werereestablished in Paycom to only display employees applicable servicecategories based their respective grants. 4. Conduct quarterly audits of timesheets and GL to ensure there are nomismatches. 5. Time study was performed on quarterly basis to ensure individualperformance complies with funders mandate. ii. Progress Update - GL and Timesheet Mismatch: 1. Audit of existing setup to review the following: a. Department(s) - revised department names/descriptions i. Made changes to all applicable employees’ setup. b. Home Allocation(s) – revised home allocation(s)i. Revised/edited the default home allocation description ii. Assigned correct default home allocation to employees c. Service Categories i. Revised/edited service categories assigned to each department 2. Observations: a. Following Paycom updates, CCGD experienced technical challenges due to software glitches which continued to result in timesheet and GL mismatches. CCGD is continuing to work with Paycom to identify and eliminate the problem. b. CCGD subsequently sought assistance from Paycom in the troubleshooting process. 3. Departmental training of timekeeping process a. Personalized standard operating procedures used b. Real-time examples/instruction provided to staff in training session(s) 4. Post-training audits conducted to include: a. Timecard/sheet review b. GL review and comparison of timecards and sheetsiii. Future Steps and Anticipated Timeline: 1. Continuation of post-training audits to include: a. Timecard/sheet review b. GL review and comparison of timecards and sheets 2. With an anticipated deadline completion date of December 31, 2023, for adherence of full compliance, CCGD effectively implemented system updates prior to this deadline to ensure payroll processing is now based on the actual time and effort performed. iv. Progress Update – Performance Activity Report 1. To provide further back up to time and effort, an additional option in Paycom was enabled for staff to enter notes on day-to-day activity. 2. Departmental training on this goal was performed and completed as of March 31, 2024. 3. Continuation of post-training audits to include: a. Timecard/sheet review b. GL review and comparison of timecards and sheets v. Post implementation plan and observation: CCGD is fully committed to complying with funders and audit standards. Furthermore, CCGD will continue to monitor and identify any potential errors in its payroll reporting to bring a timely solution if required. Furthermore, minor reporting errors occur in payroll GL reports on a random basis. The errors appear to be technical, and as such, we are currently working with Paycom to resolve this issue. Additionally, CCGD will continue to perform time study to ensure that all salary expenses and allocations are adhered to the respective program budget. Parties Responsible: Chief Executive Officer, Chief Financial Officer, and Director - Human Resources
2023-002 – Equipment and Real Property Management Policy Planned Corrective Action: Management is working on creating and implementing policies and procedures surrounding equipment and real property management. Name of Contact Persons: Darla Burkett, Executive Director, Angie Warren, Finance Manag...
2023-002 – Equipment and Real Property Management Policy Planned Corrective Action: Management is working on creating and implementing policies and procedures surrounding equipment and real property management. Name of Contact Persons: Darla Burkett, Executive Director, Angie Warren, Finance Manager and Teri Ortiz, Grants Specialist Anticipated completion date: June 30, 2024
Finding 2023-002 Condition: Suspension and debarment compliance was not verified for six covered transactions. Corrective Action Planned: The District has incorporated the language into contracts beginning with school year 2024. The language is not in the 2023 food service contracts. Anticipa...
Finding 2023-002 Condition: Suspension and debarment compliance was not verified for six covered transactions. Corrective Action Planned: The District has incorporated the language into contracts beginning with school year 2024. The language is not in the 2023 food service contracts. Anticipated Completion Date: Completed Contact: Ellen Finelli, MS. RD., Director of Food and Nutrition
Finding 2023-002, Significant Deficiency – Allowable Costs Corrective Action Plan: Goal: To ensure that duplicative expenses are not drawn down in state funding. Plan: The County identified the duplicate transaction of $20,740 reported for drawdown for Project AA 362 was due to an issue with the rep...
Finding 2023-002, Significant Deficiency – Allowable Costs Corrective Action Plan: Goal: To ensure that duplicative expenses are not drawn down in state funding. Plan: The County identified the duplicate transaction of $20,740 reported for drawdown for Project AA 362 was due to an issue with the reporting mechanism. Specifically, the report used to extract project costing details included a commitment number column, which inadvertently resulted in the creation of duplicate records for each commitment associated with a single invoice. Performance Improvement Strategies: To address this issue and prevent its recurrence in the future, immediate steps have already been taken. County Finance has amended the report to exclude the commitment number parameter, thereby eliminating the possibility of duplicate records being generated. Responsible Parties: Nursing Supervisor Brooke Hamby and Assistant Health Directors Nicole Priddy & Marie Stephens Timeframes: Brooke Hamby will reach out to the Division of Public Health, Women & Children’s Health/Children & Youth section, no later than June 15, 2024, to inform them of the Audit finding of this duplicate expense and request what the process is for returning the funds.
View Audit 308707 Questioned Costs: $1
Finding 2023-001, Significant Deficiency - Eligibility Corrective Action Plan: Goal: To ensure necessary Medicaid corrections are made by caseworkers in a timely manner and verified as completed by Medicaid management and/or Quality Assurance staff. Plan: The County will include a due date to th...
Finding 2023-001, Significant Deficiency - Eligibility Corrective Action Plan: Goal: To ensure necessary Medicaid corrections are made by caseworkers in a timely manner and verified as completed by Medicaid management and/or Quality Assurance staff. Plan: The County will include a due date to the auditing tool so that correction tasks request can be tracked and monitored for completion and accurateness. Eligibility, Internal Control and Procedural Errors will be given 5 business days to be corrected by workers. Performance Improvement Strategies: 1. Training will be given to supervisors, lead workers, and QA staff on proper usage and monitoring of due date requirements added to the audit tool. 2. Copies of reports will be stored in the shared Teams Channel for Medicaid Services. 3. Supervisor will follow up with caseworkers on 6th business days to ensure corrections have been made. 4. Every month, program managers will select 10 examples from the Medicaid Audit Finding spreadsheet to make sure supervisor have handled the error corrections made by their team. Responsible Parties: Medicaid Program Mangers Amanda Burdge, Jennifer Hurdle and Alison Westbrook Timeframes: A Medicaid Division Meeting will be held with all supervisors to discuss the expectation of monthly audits, corrections, and staying in compliance with State requirements. Also, explain the expectations of the Program Managers audit. Held no later than June 15, 2024.
Incorrect Pell Calculations Planned Corrective Action: Per our policies we will work in conjunction with Academics to ensure timely response in updating Pell based enrollment changes. Tasks will be generated to ensure both groups are reviewing in a timely manner. Person Responsible for Corrective Ac...
Incorrect Pell Calculations Planned Corrective Action: Per our policies we will work in conjunction with Academics to ensure timely response in updating Pell based enrollment changes. Tasks will be generated to ensure both groups are reviewing in a timely manner. Person Responsible for Corrective Action Plan: Ingrid Ortiz, Director of Financial Aid Anticipated Date of Completion: Implemented as of Fall 2023.
View Audit 308676 Questioned Costs: $1
Inaccurate and Untimely Return of Title IV Funds (R2T4) Planned Corrective Action: With new automation we have more timely notifications on when students have been dropped. The Pillar Financial Aid department has updated their policies to monitor the withdrawal calculations to ensure they are comple...
Inaccurate and Untimely Return of Title IV Funds (R2T4) Planned Corrective Action: With new automation we have more timely notifications on when students have been dropped. The Pillar Financial Aid department has updated their policies to monitor the withdrawal calculations to ensure they are completed within the allotted timeframe. Person Responsible for Corrective Action Plan: Ingrid Ortiz, Director of Financial Aid Anticipated Date of Completion: Implemented as of Spring 2024.
Significant changes have been made to how Finance maintains all files and documents to ensure accuracy and integrity of all reports issued by the Finance Department. Specific folders have been set up in the Shared Drive and all members of the Finance Team have appropriate access. These changes were...
Significant changes have been made to how Finance maintains all files and documents to ensure accuracy and integrity of all reports issued by the Finance Department. Specific folders have been set up in the Shared Drive and all members of the Finance Team have appropriate access. These changes were made in February 2024 and are monitored monthly by the Finance Manager and CFO.
Corrective Action: We concur with the recommendation. NASWA has implemented the following procedures to ensure that the general ledger accurately reflects approved federal grant expense and revenue activity.
Corrective Action: We concur with the recommendation. NASWA has implemented the following procedures to ensure that the general ledger accurately reflects approved federal grant expense and revenue activity.
Generation of monthly grant profit & loss statements, which are run per grant, to validate incurred expenses and revenue recognized in monthly invoice / draw down.
Generation of monthly grant profit & loss statements, which are run per grant, to validate incurred expenses and revenue recognized in monthly invoice / draw down.
Detailed review and creation of general ledger adjustments to expenses and/or revenue as grant funds are exhausted, or as other miscellaneous miscoding is discovered.
Detailed review and creation of general ledger adjustments to expenses and/or revenue as grant funds are exhausted, or as other miscellaneous miscoding is discovered.
Final review and confirmation of monthly grant profit & loss statements before signing off on final invoicing or federal fund draw down.
Final review and confirmation of monthly grant profit & loss statements before signing off on final invoicing or federal fund draw down.
Finding 400593 (2023-003)
Significant Deficiency 2023
2023-003 – Period of Performance Recommendation: We recommend that PPS enhance its procedures and internal controls to ensure that expenditures are not charged to federal awards during the period of performance. Explanation of disagreement with audit finding: There is no disagreement with the audit ...
2023-003 – Period of Performance Recommendation: We recommend that PPS enhance its procedures and internal controls to ensure that expenditures are not charged to federal awards during the period of performance. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Office of Special Education and Related services and the Portsmouth Finance department will monitor expenditures on an ongoing basis to ensure the funds are spent in accordance with the period of performance of the grant. The Finance department will review all purchases and notify the Office of Special Education if purchases are unallowable and do not follow the period of performance and have alternate suggestions on how the purchase can be made. Name(s) of the contact person(s) responsible for corrective action: Pamela Battle-Hardy, Director of Special Education and Related Services Planned completion date for corrective action plan: January 1, 2025
View Audit 308638 Questioned Costs: $1
Finding 400586 (2023-001)
Significant Deficiency 2023
2023-001 Reporting- IDIS Recommendation: We recommend that the City review its policies and procedures to ensure that compliance with federal reporting requirements are evident. Explanation of disagreement with audit finding: NO Action taken in response to finding: Review grant policy and proc...
2023-001 Reporting- IDIS Recommendation: We recommend that the City review its policies and procedures to ensure that compliance with federal reporting requirements are evident. Explanation of disagreement with audit finding: NO Action taken in response to finding: Review grant policy and procedures to ensure that City’s policy and procedure is in compliance with federal reporting requirements. Name(s) of the contact person(s) responsible for corrective action: Jeffrey Crimer, Doug Weller, Kyera Pope. Planned completion date for corrective action plan: 06/30/2024.
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