FINDING 2022-004
Finding Subject: COVID-19 - Coronavirus State and Local Fiscal Recovery Funds - Reporting
Summary of Finding:
The County Health Department was required to submit data through the online portal, National Electronic
Disease Surveillance System Base System, monthly beginning in October...
FINDING 2022-004
Finding Subject: COVID-19 - Coronavirus State and Local Fiscal Recovery Funds - Reporting
Summary of Finding:
The County Health Department was required to submit data through the online portal, National Electronic
Disease Surveillance System Base System, monthly beginning in October 2022. The submitted data included
program specific metrics related to patient case management of certified Elevated Blood Lead Levels.
A Case Manager managed all aspects of an individual patient’s care. Once a patient’s care was complete, the
case was closed by the Case Manager in the online portal. Completed cases were compiled by the Clinical
Manager into a data sheet, which was then submitted to the Manager of Administration. The Manager of
Administration based on the compiled data sheet prepared and submitted a reimbursement request to the State
without an oversight, review, or approval process to ensure the reimbursement request was complete and
accurate.
Recommendation:
We recommended that management of the County design and implement a proper system of internal controls,
including policies and procedures that would provide segregation of duties to ensure appropriate reviews,
approvals, and oversight are taking place to ensure reports are complete and accurate.”
Contact Person Responsible for Corrective Action: Concetta Sanfilippo
Contact Phone Number and Email Address: 574.523.2101 csanfilippo@elkhartcounty.com
Views of Responsible Officials:
Option 2: “We disagree with part of the finding.”
Explanation and Reason for Disagreement: The County already has an established process of review and
evaluation. The Case Manager’s reports on work are reported to their superior, the Clinical Manager. The Clinical
Manager reviews data, enters report data into the program portal as required. A spreadsheet with case start
date, patient ID number, home address and payment is submitted to the Manager of Administration who acts as
secondary review and completes the invoice and submits it to the State where an additional process of review
is then executed before approval and federal funds are drawn.
Once the invoice is submitted, the Manager of Administration makes two copies of the invoice and the
spreadsheet, one copy is sent to the Clinical Manager and the other to the Auditors office. This is an excellent
procedure for checking and balance.
Description of Corrective Action Plan: The Elkhart County Health Department receives elevated blood lead
levels from the State. The Lead Case Manager determines if criteria are met to initiate a case. They conduct a
home visit and make appropriate referrals. The lead case manager enters case information into NBS.
INDIANA STATE BOARD OF ACCOUNTS
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Ongoing case management for children with elevated blood leads levels includes coordination of blood lead
tests, education, and appropriate referrals.
The Lead Case Manager submits a list of cases each month to the Clinical Manager that meet the criteria for
submission for reimbursement. The criteria are a completed home visit, a completed nutrition assessment, a
referral for developmental assessment and documentation in NBS. The Clinical Manager reviews the cases in
NBS and compiles a list and submits the data sheet to the Fiscal Manager. The Fiscal Manager prepares the
invoice and submits it along with documentation to the State and Timothy Conley for review and approval.
The Elkhart County Health Department will continue to have collaborative compilation of data which will be
reviewed by field specialists before being submitted to the Manager of Administration for invoice reimbursement.
The data and records are reviewed by the Manager of Administration and the invoice total will be confirmed and
documented with the Clinical Manager prior to being submitted to the State for review and approval. Confirmation
emails of secondary review will be retained as documentation.
The State must approve invoices with supporting documentation and is the external party requesting
reimbursement with Federal funds once approved. A copy of supporting documentation is supplied to the Elkhart
County Auditor’s Office to be retained on file and to be used for receipting records once reimbursement is
received and deposited into its unique 8000 series fund.
Anticipated Completion Date: August of 2023
(Note: Provide the projected date of completion of major tasks for the planned corrective actions.)