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Corrective Action Plans

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Finding 538653 (2024-001)
Material Weakness 2024
Siskiyou Communith Health Center
OR
Special Tests & Provisions Material Weakness Significant Deficiency
2024-001 Special Tests and Provisions Corrective action planned: Management has selected a General Ledger account, (associated to a separate Bank Account) identified and named specifically as the USDA Debt Reserve Account.Additionally, Financial Policies will be revised to include language related t...
2024-001 Special Tests and Provisions Corrective action planned: Management has selected a General Ledger account, (associated to a separate Bank Account) identified and named specifically as the USDA Debt Reserve Account.Additionally, Financial Policies will be revised to include language related to compliance of loan and debt covenants, to be reviewed and approved by the Board of Directors. Anticipated completion date: February 2025 Contact person responsible for corrective action: Dawn Weber, Interim CEO
View Audit 349388
Finding 538652 (2024-005)
Significant Deficiency 2024
Sioux Falls School District 49-5
SD
Reporting Significant Deficiency Internal Control / Segregation of Duties
Identifying Number: 2024-005: U.S. Department of Education: Education Stabilization Fund: Institutional Portion – 84.425F Finding: There was no review of quarterly or annual HEERF reports prior to their submission. Corrective Action Taken or Planned: The School will train finance office staff in pre...
Identifying Number: 2024-005: U.S. Department of Education: Education Stabilization Fund: Institutional Portion – 84.425F Finding: There was no review of quarterly or annual HEERF reports prior to their submission. Corrective Action Taken or Planned: The School will train finance office staff in preparation and filing of grant reports. This will allow various staff members to review reports prior to submission. Contact person: Mike Stephens, Director of Accounting Status of finding – The above corrective actions will be implemented beginning April 1, 2025.
View Audit 349380
Finding 538648 (2024-007)
Significant Deficiency 2024
Sioux Falls School District 49-5
SD
Student Financial Aid Reporting Subrecipient Monitoring
Identifying Number: 2024-007: U.S. Department of Education: Federal Direct Student Loans – 84.268 Finding: During testing of enrollment reporting, it was noted that there were 16 instances in which the student’s status change was certified outside the 60-day reporting requirement. Corrective Action ...
Identifying Number: 2024-007: U.S. Department of Education: Federal Direct Student Loans – 84.268 Finding: During testing of enrollment reporting, it was noted that there were 16 instances in which the student’s status change was certified outside the 60-day reporting requirement. Corrective Action Taken or Planned: We learned that the current process for the submission to the National Student Clearinghouse is not pulling all students that it should be. We are now pulling additional reports to identify those students being missed and are manually reporting them to the Clearinghouse. Contact person: Megan Fischer, Vice President for Enrollment Management Status of finding – The above corrective actions will be implemented beginning January 1, 2025.
View Audit 349380
Finding 538647 (2024-006)
Significant Deficiency 2024
Sioux Falls School District 49-5
SD
Student Financial Aid Significant Deficiency Matching / Level of Effort / Earmarking
Identifying Number: 2024-006: U.S. Department of Education: Federal Direct Student Loans – 84.268 Finding: During testing over credit balances, it was noted that: 1) one student did not receive the refund on a timely basis; and 2) two students had amounts applied to a prior-year balance over $200. C...
Identifying Number: 2024-006: U.S. Department of Education: Federal Direct Student Loans – 84.268 Finding: During testing over credit balances, it was noted that: 1) one student did not receive the refund on a timely basis; and 2) two students had amounts applied to a prior-year balance over $200. Corrective Action Taken or Planned: All scheduled disbursements will be reviewed to ensure they are provided on a timely basis and are applied correctly to prior award years. Business Office procedures and processing will be reviewed to ensure that credit balances are processed within the regulatory timeframe. Contact person: Megan Fischer, Vice President for Enrollment Management Status of finding – The above corrective actions will be implemented beginning April 1, 2025.
View Audit 349380
Finding 538646 (2024-001)
Significant Deficiency 2024
Willcox Unified School District No. 13
AZ
Subrecipient Monitoring Reporting Significant Deficiency
Finding Number: 2024‐001 Program Name/Assistance Listing Title: Education Stabilization Fund Assistance Listing Number: 84.425U Contact Person: Kevin Davis, Superintendent & Business Manager Anticipated Completion Date: June 30, 2025 Planned Corrective Action: This finding related to fede...
Finding Number: 2024‐001 Program Name/Assistance Listing Title: Education Stabilization Fund Assistance Listing Number: 84.425U Contact Person: Kevin Davis, Superintendent & Business Manager Anticipated Completion Date: June 30, 2025 Planned Corrective Action: This finding related to federal grants, specifically ESSER Funds was due to changing requirements in the program, the newness of the ESSER grants, and lack of training for our grants manager  as  they  were  also  new  to  the  position.  Additional  grants  training  will  be  conducted  for  this  individual and be completed by July 15, 2025. As our ESSER grants have been expended and completion reports finalized by Grants Management, with no issues or errors found, this should not be an issue in the future. Supervision will be monitored more closely by the Superintendent to ensure proper standards are met.
View Audit 349379
Finding 538543 (2024-072)
Significant Deficiency 2024
State of Maine
ME
Significant Deficiency Special Tests & Provisions
Department: Redacted Title: ________ over the ________ and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department partially agrees with the finding. The Department’s corrective action plan as well as the explanation and specific reas...
Department: Redacted Title: ________ over the ________ and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department partially agrees with the finding. The Department’s corrective action plan as well as the explanation and specific reasons for disagreement have been excluded to protect confidential information. The complete corrective action plan as well as the explanation and specific reasons for disagreement have been provided to the Office of the State Auditor under separate cover. Completion Date: December 1, 2025 Agency Contact: Shirley Browne, Deputy State Controller, Office of the State Controller, 207-626-8423
View Audit 349360
Finding 538535 (2024-070)
Significant Deficiency 2024
State of Maine
ME
Allowable Costs / Cost Principles Internal Control / Segregation of Duties HUD Housing Programs § 200.303
Department: Health and Human Services Title: Internal control over Medicaid drug rebates needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: PRIMS (Pharmacy Rebate Information Management System), provided to the State of ...
Department: Health and Human Services Title: Internal control over Medicaid drug rebates needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: PRIMS (Pharmacy Rebate Information Management System), provided to the State of Maine by a third-party vendor, is a proven system in production in many locations and PRIMS has passed a wide variety of Federal and State audits. The drug rebate program is complex and there are numerous steps in the process which have already been demonstrated and/or provided to the Office of State Auditor. The controls described to the State Auditor previously (Pre-invoicing controls, pharmacy claims controls and medical claims controls) address all three of the Auditors’ Recommendations. Completion Date: N/A Agency Contact: Michelle Probert, Director, Office of MaineCare Services, DHHS, 207-287-2093
View Audit 349360
Finding 538527 (2024-068)
Significant Deficiency 2024
State of Maine
ME
Allowable Costs / Cost Principles Eligibility Internal Control / Segregation of Duties § 200.303
Department: Health and Human Services Title: Internal control over Medicare Part B premium payments needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The MaineCare Program management team will work with the Data Team to explore opportunities to improve...
Department: Health and Human Services Title: Internal control over Medicare Part B premium payments needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The MaineCare Program management team will work with the Data Team to explore opportunities to improve the report to reduce duplication of effort and improve overall efficiency and effectiveness of the review. The MaineCare Program management team will review relevant guidance material, clarify expectations and adjust standard operating procedures for further efficiency and oversight improvements. Completion Date: June 30, 2025 Agency Contact: Ian Yaffe, Director, Office for Family Independence, DHHS, 207- 592-1481
View Audit 349360
Finding 538521 (2024-066)
Significant Deficiency 2024
State of Maine
ME
Significant Deficiency Special Tests & Provisions
Department: Redacted Title: ________ over ________, ________, and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential infor...
Department: Redacted Title: ________ over ________, ________, and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The complete corrective action plan has been provided to the Office of the State Auditor under separate cover. Completion Date: June 1, 2025 Agency Contact: Shirley Browne, Deputy State Controller, Office of the State Controller, 207-626-8423
View Audit 349360
Finding 538513 (2024-062)
Significant Deficiency 2024
State of Maine
ME
Significant Deficiency Special Tests & Provisions
Department: Redacted Title: ________ over ________ and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The...
Department: Redacted Title: ________ over ________ and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The complete corrective action plan has been provided to the Office of the State Auditor under separate cover. Completion Date: June 1, 2025 Agency Contact: Shirley Browne, Deputy State Controller, Office of the State Controller, 207-626-8423
View Audit 349360
Finding 538508 (2024-060)
Significant Deficiency 2024
State of Maine
ME
Internal Control / Segregation of Duties Subrecipient Monitoring Significant Deficiency § 200.303
Department: Health and Human Services Title: Internal control over CCDF provider health and safety requirements needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Office of Child and Family Services (OCFS) will launch a new data management system (B...
Department: Health and Human Services Title: Internal control over CCDF provider health and safety requirements needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Office of Child and Family Services (OCFS) will launch a new data management system (Baxter) that includes mobile technology (eliminating paper inspections), has extensive reporting, data, tracking technology and system alerts to inform Licensing Specialists and Supervisors of inspection due dates. Enhanced technology will mitigate the risk associated w/ current manual procedures. OCFS will include an agenda item on the next Child Care Licensing Staff meeting regarding annual inspection completion. OCFS will update Standard Operating Procedures to reflect changes in workflow and processes because of the new data management system. Completion Date: May 19, 2025, April 1, 2025, and June 1, 2025 Agency Contact: Janet Whitten, OCFS, CLIS Program Manager, DHHS, 207-441-2259
View Audit 349360
Finding 538504 (2024-058)
Significant Deficiency 2024
State of Maine
ME
Internal Control / Segregation of Duties Special Tests & Provisions Subrecipient Monitoring § 200.303
Department: Health and Human Services Title: Internal control over TANF work verification plan procedures needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The TANF Program Manager will review and update ACF 199/209 system processes within OFI to enhan...
Department: Health and Human Services Title: Internal control over TANF work verification plan procedures needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The TANF Program Manager will review and update ACF 199/209 system processes within OFI to enhance existing procedures to ensure that the information reported on the ACF-199 and ACF-209 reports is accurate and complete prior to submission to the Federal government. This will include modifying existing Standard Operating Procedures as necessary. The TANF Senior Program Manager will enhance existing procedures and follow-up processes of the ACRT reviews to ensure that the reviews include information regarding the date the review was conducted and the dates on which any outstanding issues are resolved. Completion Date: June 30, 2025 Agency Contact: Ian Yaffe, Director, Office for Family Independence, DHHS, 207-592-1481
View Audit 349360
Finding 538503 (2024-057)
Significant Deficiency 2024
State of Maine
ME
Internal Control / Segregation of Duties Eligibility Reporting § 200.303
Department: Health and Human Services Title: Internal control over TANF performance reporting procedures needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will review and update ACF 199/209 system processes within Office for Family Indep...
Department: Health and Human Services Title: Internal control over TANF performance reporting procedures needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will review and update ACF 199/209 system processes within Office for Family Independence to enhance existing procedures to ensure that the information reported on the ACF-199 and ACF-209 reports is accurate and complete prior to submission to the Federal government. This will include modifying the existing Standard Operating Procedure as necessary. Completion Date: June 30, 2025 Agency Contact: Ian Yaffe, Director, Office for Family Independence, DHHS, 207- 592-1481
View Audit 349360
Finding 538500 (2024-054)
Significant Deficiency 2024
State of Maine
ME
Internal Control / Segregation of Duties Special Tests & Provisions Student Financial Aid § 200.303
Department: Health and Human Services Title: Internal control over TANF client child support sanction procedures needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. The audit ob...
Department: Health and Human Services Title: Internal control over TANF client child support sanction procedures needs improvement Questioned Costs: None Status: Management’s opinion is that corrective action is not required Corrective Action: The Department disagrees with this finding. The audit objective identified in the Compliance Supplement is to "Determine whether, after notification by the state Title IV-D agency, the TANF agency has taken necessary action to reduce or deny TANF assistance." One of the two suggested audit procedures is to "Test a sample of cases referred by the Title IV-D agency to the TANF agency to ascertain if benefits were reduced or denied as required." The Department spent a lot of time and effort attempting to validate for OSA that it had a testable population, and the Department believes that the Office of State Auditor can perform this procedure either with the DSER-provided report of referrals or with that report in conjunction with the additional material (including active sanction activity within the fiscal year as provided by OFI) the Department has pulled and analyzed for OSA. In the absence of that review nothing in the Department’s records, data, or discussions with OSA could reasonably be interpreted to suggest a “significant deficiency” in its Internal Controls over this aspect of the TANF program. There has not been any evidence that referrals made from DSER to OFI are getting lost, ignored, or misapplied. Completion Date: N/A Agency Contact: Ian Yaffe, Director, Office for Family Independence, DHHS, 207-592-1481
View Audit 349360
Finding 538496 (2024-051)
Significant Deficiency 2024
State of Maine
ME
Significant Deficiency Special Tests & Provisions
Department: Redacted Title: ________ over the ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The complete...
Department: Redacted Title: ________ over the ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The complete corrective action plan has been provided to the Office of the State Auditor under separate cover. Completion Date: December 31, 2025 Agency Contact: Shirley Browne, Deputy State Controller, Office of the State Controller, 207-626-8423
View Audit 349360
Finding 538464 (2024-040)
Significant Deficiency 2024
State of Maine
ME
Internal Control / Segregation of Duties Special Tests & Provisions Subrecipient Monitoring § 200.303
Department: Labor Title: Internal control over UI overpayments needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department has filed a defect ticket with the helpdesk. In the process of finalizing scope, analyzing solution. System chan...
Department: Labor Title: Internal control over UI overpayments needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department has filed a defect ticket with the helpdesk. In the process of finalizing scope, analyzing solution. System changes anticipated to be resolved. The Department will monitor parameters to confirm overpayments are set up correctly. An SOP documenting these monitoring parameters is in process. The Department will add system parameters to run an extract once a quarter for review and validate overpayment system functionality. Test that rules are functioning per the MDOL solution. The Department has notified the Division of Administrative Hearings and staff training will be completed. Completion Date: December 21, 2025, June 30, 2025, September 30, 2025, and March 31, 2025, respectively Agency Contact: Suzan McKechnie Director, Bureau of Unemployment Compensation, DOL, 207-621-5126
View Audit 349360
Finding 538462 (2024-039)
Significant Deficiency 2024
State of Maine
ME
Eligibility Internal Control / Segregation of Duties Allowable Costs / Cost Principles § 200.303
Department: Labor Title: Internal control over UI claim payments needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department concluded a system build in January 2025 to implement controls to prevent repetitive waivers. Completion Date: March 30, 2...
Department: Labor Title: Internal control over UI claim payments needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department concluded a system build in January 2025 to implement controls to prevent repetitive waivers. Completion Date: March 30, 2025 Agency Contact: Suzan McKechnie, Director, Bureau of Unemployment Compensation, DOL, 207-621-5126
View Audit 349360
Finding 538460 (2024-038)
Significant Deficiency 2024
State of Maine
ME
Cash Management Significant Deficiency § 200.302 § 200.303
Department: Health and Human Services Administrative and Financial Services Title: Internal control over WIC cash balances needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will contact the Federal Awarding Agency to identify steps neede...
Department: Health and Human Services Administrative and Financial Services Title: Internal control over WIC cash balances needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will contact the Federal Awarding Agency to identify steps needed to resolve the cash discrepancy. Completion Date: September 30, 2025 Agency Contact: Sarah Gove, Director, DHHS Service Center, DAFS, 207-458-6626
View Audit 349360
Finding 538448 (2024-035)
Significant Deficiency 2024
State of Maine
ME
Reporting School Nutrition Programs Equipment & Real Property Management § 200.303
Department: Education Title: Internal control over CNC donated food inventory needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will follow up on open CNPWeb tickets for completion. The Department will work with the vendor to create a n...
Department: Education Title: Internal control over CNC donated food inventory needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department will follow up on open CNPWeb tickets for completion. The Department will work with the vendor to create a new computerized system to receive tickets and print them automatically to remove the manual process of writing tickets. The Department will initiate meetings each month to compare inventory numbers, if they do not match. The Department will work with the vendor to replace any missing item from their inventory with an equal product each month. Completion Date: March 31, 2025 first item, December 1, 2025 second item and April 30, 2025 third and fourth item Agency Contact: Jane McLucas, Director of Child Nutrition, DOE, 207-624-6880
View Audit 349360
Finding 538415 (2024-029)
Significant Deficiency 2024
State of Maine
ME
Significant Deficiency Special Tests & Provisions
Department: Redacted Title: ________ over ________ and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The...
Department: Redacted Title: ________ over ________ and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The complete corrective action plan has been provided to the Office of the State Auditor under separate cover. Completion Date: September 17, 2024, and June 30, 2025, respectively Agency Contact: Shirley Browne, Deputy State Controller, Office of the State Controller, 207-626-8423
View Audit 349360
Finding 538411 (2024-028)
Significant Deficiency 2024
State of Maine
ME
Significant Deficiency Special Tests & Provisions
Department: Redacted Title: ________ over the ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The complete...
Department: Redacted Title: ________ over the ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The complete corrective action plan has been provided to the Office of the State Auditor under separate cover. Completion Date: June 30, 2025 Agency Contact: Shirley Browne, Deputy State Controller, Office of the State Controller, 207-626-8423
View Audit 349360
Finding 538407 (2024-027)
Significant Deficiency 2024
State of Maine
ME
Significant Deficiency Special Tests & Provisions
Department: Redacted Title: ________ over ________ and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The...
Department: Redacted Title: ________ over ________ and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The complete corrective action plan has been provided to the Office of the State Auditor under separate cover. Completion Date: June 1, 2025 Agency Contact: Shirley Browne, Deputy State Controller, Office of the State Controller, 207-626-8423
View Audit 349360
Finding 538402 (2024-026)
Significant Deficiency 2024
State of Maine
ME
Subrecipient Monitoring Internal Control / Segregation of Duties Reporting § 200.303
Department: Health and Human Services Title: Internal control over DHHS special reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Division of Contract Management will work with program staff and the Service Center Grants Team to ensure gr...
Department: Health and Human Services Title: Internal control over DHHS special reporting needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Division of Contract Management will work with program staff and the Service Center Grants Team to ensure grant information is captured and recorded timely and accurately. The Department will establish meetings to ensure DCM, Service Center and Program staff establish policies to ensure accuracy in FFATA reporting process. Completion Date: September 30, 2025 and May 31, 2025, respectively Agency Contact: Jeanne Garza, Deputy Director, DCM, DHHS, 207-287-1848
View Audit 349360
Finding 538390 (2024-021)
Significant Deficiency 2024
State of Maine
ME
Significant Deficiency Special Tests & Provisions
Department: Redacted Title: ________ over ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The complete cor...
Department: Redacted Title: ________ over ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The complete corrective action plan has been provided to the Office of the State Auditor under separate cover. Completion Date: June 30, 2025 Agency Contact: Shirley Browne, Deputy State Controller, Office of the State Controller, 207-626-8423
View Audit 349360
Finding 538379 (2024-020)
Significant Deficiency 2024
State of Maine
ME
Significant Deficiency Special Tests & Provisions
Department: Redacted Title: ________ over ________ and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The...
Department: Redacted Title: ________ over ________ and ________ needs improvement Questioned Costs: None Status: Corrective action in progress Corrective Action: The Department agrees with the finding. The Department’s corrective action plan has been excluded to protect confidential information. The complete corrective action plan has been provided to the Office of the State Auditor under separate cover. Completion Date: September 1, 2024 Agency Contact: Shirley Browne, Deputy State Controller, Office of the State Controller, 207-626-8423
View Audit 349360
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