FINDING 2023-002
Finding Subject: COVID‐19 ‐ Coronavirus State and Local Fiscal Recovery Funds ‐ Reporting
Summary of Finding:
The Elkhart County Health Department (Health Department) was awarded the Health Issues and Challenges
Grant through the Indiana Department of Health (IDOH) financed through ...
FINDING 2023-002
Finding Subject: COVID‐19 ‐ Coronavirus State and Local Fiscal Recovery Funds ‐ Reporting
Summary of Finding:
The Elkhart County Health Department (Health Department) was awarded the Health Issues and Challenges
Grant through the Indiana Department of Health (IDOH) financed through the Coronavirus State and Local Fiscal
Recovery Funds The grant was funded through the American Rescue Plan Act that focused on the improvement
of chronic disease, and more specifically, elevated blood lead level reduction.
The Health Department was required to submit data through the online portal, National Electronic Disease
Surveillance System (NEDSS) Base System (NBS) each month. The submitted data included program specific
metrics related to patient case management of certified Elevated Blood Lead Levels (EBLLs). A Case Manager
managed all aspects of an individual patient's care. A home visit and two assessments were completed by the
Case Manager and input into the NBS. Once these steps were marked as complete in the NBS, the Clinical
Manager reviewed each case and compiled data along with the cost reimbursement amount into a spreadsheet.
The Clinical Manager provided the spreadsheet to the Manager of Administration who then completed and
submitted the reimbursement invoice to the IDOH. The reimbursement invoice was submitted without a
documented oversight, review, or approval process to ensure the accuracy of the data prior to submission.
Beginning in October 2022, the Health Department was required to submit program specific metrics and work
plan data through RedCap software on a quarterly basis. The Case Manager was responsible for tracking and
compiling the necessary information for the quarterly reports. Of the four reports tested, two reports were
submitted late. In addition, the quarterly reports were submitted by the Case Manager via the RedCap software
without a documented oversight, review, or approval process to ensure timely submission.
Recommendation:
We recommend the Health Department implement a formal oversight and review process for all data
submissions to ensure accuracy and completeness before they are submitted to Indiana Department of Health
(IDOH). This would involve a secondary review by a designated individual or team to verify the data. Additionally,
improving workflow coordination through clearly defined roles and responsibilities for each team member would
help streamline the process and prevent delays. To further improve timeliness, the Health Department should
implement a tracking and reminder system for report due dates and reimbursement deadlines to ensure timely
submissions. Providing staff with thorough training on reporting protocols and maintaining detailed
documentation will help ensure consistent adherence to procedures. Finally, establishing accountability
measures through clear roles, deadlines, and regular audits would enhance the efficiency and effectiveness of
the reporting process. These steps will help ensure the Health Department meets grant requirements, maintains
data accuracy, and avoids potential delays or issues in future submissions.
INDIANA STATE BOARD OF ACCOUNTS
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Contact Person Responsible for Corrective Action: Concetta Sanfilippo
Contact Phone Number and Email Address: 574.523.2101 csanfilippo@elkhartcounty.com
Views of Responsible Officials:
We concur with the finding
Description of Corrective Action Plan:
During the prior audit we were informed of the deficiencies in our controls over the reimbursement requests
submitted to the Department of Health. Unfortunately, due to the timing of the finding being brought to our
attention near the end of its lifecycle we were unable to implement controls. With only one month remaining
between the audit finding results and the grant’s end date, implementing the stated corrective action plan was
deemed impractical. The Elkhart County Health Department has internal controls and policies for the grants that
are received. This grant was very different from the other grants we have received in the past.
Since the Elevated Blood Lead Level Reduction grant differed significantly from previous grants received by the
Elkhart County Health Department, moving forward, if the department chooses to pursue and secure another
grant with a similar scope, enhanced controls and policies will be implemented to strengthen accuracy and
accountability. Specifically, the Health Department will establish a formal data review process. All data
submissions will undergo an initial review, followed by a secondary verification conducted by a designated staff
member. This dual review procedure will apply to all future grants of a similar nature to ensure the integrity and
reliability of submitted information.
The goal is to ensure there is an appropriate system of checks and balances, as well as a remediation/correction
step, in place for all tasks and documentation related to grant-funded duties and invoicing.
Anticipated Completion Date:
Effective June 30, 2025 the Elkhart County Department of Health will implement this practice for all newly
accepted grants similar in scope to the Elevated Blood Lead Level Reduction.