Corrective Action Plans

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Responsible Contact Person(s): David Portner, Chief Information Officer Corrective Action Planned: This finding was marked as FOIA Exempt (FOIAE) and as a result, the State Comptroller has determined that the resulting corrective actions are FOIAE under ?2.2-3705.2 (9.) of the Code of Virginia. Fed...
Responsible Contact Person(s): David Portner, Chief Information Officer Corrective Action Planned: This finding was marked as FOIA Exempt (FOIAE) and as a result, the State Comptroller has determined that the resulting corrective actions are FOIAE under ?2.2-3705.2 (9.) of the Code of Virginia. Federal awarding agencies and pass-through entities, please see the Appendix titled ?Applicable Management Contacts for Findings and Questioned Costs? to request the corrective action planned from the applicable entity. Estimated Completion Date: 4/30/2023
Responsible Contact Person(s): William Walton, Deputy Commissioner for Unemployment Insurance Corrective Action Planned: The Quality Control (QC) Manager developed a work plan outlining all required reviews and their respective due dates. A backup to the TPS analyst position was added to the QC Uni...
Responsible Contact Person(s): William Walton, Deputy Commissioner for Unemployment Insurance Corrective Action Planned: The Quality Control (QC) Manager developed a work plan outlining all required reviews and their respective due dates. A backup to the TPS analyst position was added to the QC Unit in February 2023, and the QC Manager is working with both positions to ensure proper training is provided, policies and procedures are updated, and reviews are conducted uniformly and timely. The QC Manager will perform a review of all completed reviews to ensure consistency in decision outcomes. The QC Manager is also working with VEC IT to ensure system issues that may cause delays in sample selections are identified and resolved timely. A "TPS Desk Reference" will be compiled throughout the next TPS Cycle to ensure continuity of operations and clear direction. Estimated Completion Date: 3/31/2023
Responsible Contact Person(s): Melinda Raines, Director of Human Resources Karen Holt, Human Resources Business Process Consultant Corrective Action Planned: Corrective Action Plan: In 2018, the Virginia Department of Social Services (DSS) implemented written procedures to administer the Conflict of...
Responsible Contact Person(s): Melinda Raines, Director of Human Resources Karen Holt, Human Resources Business Process Consultant Corrective Action Planned: Corrective Action Plan: In 2018, the Virginia Department of Social Services (DSS) implemented written procedures to administer the Conflict of Interests Act (COIA) as outlined in the Code of Virginia. While an SOEI policy was not created, the procedures were clear, documented, and administered. DSS continues to refine its written procedures and correct identified deficiencies to meet compliance with the COIA. In January 2022, DSS began the process to have oversight responsibility for the COIA reassigned to another Human Resources (HR) unit. HR continues to evaluate and update the approach used to identify and track employees in a position of trust upon hire or change in responsibilities. Prior to the annual disclosure process the SOEI coordinator will review positions against Executive Order 18 (2022) to confirm positions within the agency that are designated as positions of trust. Division directors from various areas will be consulted with to determine if any positions involving contracts, licenses, audits, budgets, policy, or grants should be designated in a position of trust. Team members from HR will review the designation list and any additions or removals from the prior year will be updated in the economic interest field in the statewide accounting system. To capture new hires and transfers in a position of trust throughout the year, the SOEI coordinator will review the new hire and transfer report for the agency twice per month. When a new hire or transfer is moving into a position of trust the employee?s information will be added into the Conflict of Interest Disclosure System. Notifications will be sent requesting the disclosure form is completed on or prior to the employee?s start date. The system will be monitored to track progress of completion. Should the employee not complete the financial disclosure, the employee?s supervisor will be notified. When new employees in a position of trust receive access to the Commonwealth of Virginia Learning Center (COVLC), they are enrolled into the conflict of interest (COI) training and provided a deadline for completing the course. The SOEI coordinator will monitor the COVLC system for completion. Should the employee not complete the orientation training, the employee?s supervisor will be notified. To improve monitoring and tracking of COI training every two years, a spreadsheet will be maintained listing training completion dates. The report will be monitored on the same schedule as the new hire and transfer report. The spreadsheet will flag a filer?s record when the most recent training date approaches the two year mark and needs to be retaken. HR will then enroll the employee in the COI training, notify the employee and the employee?s manager of the training requirement, and monitor for completion. Reassigning oversight of the COIA to another HR unit and following the updated written procedures should show considerable improvement and compliance with the agency?s monitoring of the COIA by April 1, 2024. Estimated Completion Date: 4/1/2024
Responsible Contact Person(s): Paula Garrett, WIC Director Corrective Action Planned: The Remote Services Policy was updated and sent to local agency staff on January 21st. The updated policy included clarifying information about scanning in the affidavit so it is viewable in the record. An additi...
Responsible Contact Person(s): Paula Garrett, WIC Director Corrective Action Planned: The Remote Services Policy was updated and sent to local agency staff on January 21st. The updated policy included clarifying information about scanning in the affidavit so it is viewable in the record. An additional update to the policy will include a requirement for documentation as to why the affidavit is needed. Once in-person services resume, the normal policies and procedures for required affidavits will resume. Estimated Completion Date: 8/31/2023
Responsible Contact Person(s): Lisa Hawkins, Director - Information Technology Business Administration Corrective Action Planned: DSS has 15 applications that are in active oversight, IT Business Administration is in receipt of 14 of the 15 required SOC reports, the final SOC report is due at the e...
Responsible Contact Person(s): Lisa Hawkins, Director - Information Technology Business Administration Corrective Action Planned: DSS has 15 applications that are in active oversight, IT Business Administration is in receipt of 14 of the 15 required SOC reports, the final SOC report is due at the end of Q1 2023. Estimated Completion Date: 2/1/2023
Responsible Contact Person(s): Jennifer Cooper, Associate Director Senior Diana Clark, Compliance Coordinator Corrective Action Planned: A risk assessment tool was developed as part of the SFY2024 SRM Plan and will be implemented with the new plan. Estimated Completion Date: 6/30/2023
Responsible Contact Person(s): Jennifer Cooper, Associate Director Senior Diana Clark, Compliance Coordinator Corrective Action Planned: A risk assessment tool was developed as part of the SFY2024 SRM Plan and will be implemented with the new plan. Estimated Completion Date: 6/30/2023
Responsible Contact Person(s): Jennifer Cooper, Associate Director Senior Diana Clark, Compliance Coordinator Corrective Action Planned: Coordinator reviews the completed audit documents to ensure that all required audit documents are uploaded to the website based collaboration system timely and tha...
Responsible Contact Person(s): Jennifer Cooper, Associate Director Senior Diana Clark, Compliance Coordinator Corrective Action Planned: Coordinator reviews the completed audit documents to ensure that all required audit documents are uploaded to the website based collaboration system timely and that reviews are conducted in accordance with the SRM Plan. A SRM monitoring desk tool will be created for Practice Consultants as a quick reference to the SRM Plan. Training for all Program Consultants conducting SRM will be provided on the new updated monitoring plan as well as ongoing training for newly hired Program Consultants. Estimated Completion Date: 6/30/2023
Bank Reconciliations Auditor?s Recommendation: As part of the bank reconciliation preparation and review, the City?s general ledger cash balances should be compared against the bank reconciliation, with any differences being immediately investigated and corrected. City?s response: The City Auditor,...
Bank Reconciliations Auditor?s Recommendation: As part of the bank reconciliation preparation and review, the City?s general ledger cash balances should be compared against the bank reconciliation, with any differences being immediately investigated and corrected. City?s response: The City Auditor, Lens Martial, understands the importance of the bank reconciliation process and will investigate and correct any reconciling differences as they occur. Differences existed related to the timing of payroll transfers made from the general checking account to the payroll account. The City Auditor will put a process in place to verify that these transactions are properly accounted for on the bank reconciliations during the year ending May 31, 2023.
Capital Projects ? Internal Controls Auditor?s Recommendations: Budgets ? A written policy should be established and communicated on preparing a budget versus actual report for all capital projects exceeding a certain dollar level. Any discrepancies should be explained in writing so that necessary...
Capital Projects ? Internal Controls Auditor?s Recommendations: Budgets ? A written policy should be established and communicated on preparing a budget versus actual report for all capital projects exceeding a certain dollar level. Any discrepancies should be explained in writing so that necessary corrective action, if any, can be considered. These analyses should be provided to City management and the Common Council on a monthly basis. City?s response: Budgets - The City concurs with the auditor?s recommendations that a written policy should be established and communicated in preparing budgeted versus actual reporting for capital project budgets in excess of a yet to be determined monetary threshold. The City intends to develop a policy on budgets during 2023. Once drafted, the Audit and Compliance Committee intends to review policy, prior to its acceptance by the Common Council.
Reconciliation of General Ledger and Capital Projects Auditor?s Recommendation: We recommend that asset and liability accounts be reconciled by the City Auditor?s office on a regular and routine basis. Further, reconciliations should be reviewed by management to ensure their accurate and timely com...
Reconciliation of General Ledger and Capital Projects Auditor?s Recommendation: We recommend that asset and liability accounts be reconciled by the City Auditor?s office on a regular and routine basis. Further, reconciliations should be reviewed by management to ensure their accurate and timely completion. City?s response: The City Auditor, Lens Martial, will take the necessary steps to remedy this issue during the year ending May 31, 2023. A reconciliation of all asset and liability balances will be performed on a monthly basis by the City Auditor. Additionally the City Auditor will take the necessary steps to ensure the general ledger packages reconcile and agree to one and other on a regular basis.
Adjusting Journal Entries and Required Disclosures to the Financial Statements Auditor?s Recommendation: Although auditors may continue to provide such assistance both now and in the future, under this pronouncement, the City should continue to review and accept both proposed adjusting journal entri...
Adjusting Journal Entries and Required Disclosures to the Financial Statements Auditor?s Recommendation: Although auditors may continue to provide such assistance both now and in the future, under this pronouncement, the City should continue to review and accept both proposed adjusting journal entries and footnote disclosures, along with the draft financial statements. City?s Response: The City Auditor, Lens Martial, has received, reviewed and approved all journal entries, footnote disclosures and draft financial statements proposed for the current year audit and will continue to review similar information for the year ending May 31, 2023 and in future years. Further, the City believes it has a thorough understanding of these financial statements and has the ability to make informed judgments based on these financial statements.
Finding: Per 2 CFR 200.303, the Council must establish and maintain effective internal controls over federal awards that provide reasonable assurance that it is managing federal awards in compliance with federal statutes, regulations and provisions of contracts or grant agreements that could have a ...
Finding: Per 2 CFR 200.303, the Council must establish and maintain effective internal controls over federal awards that provide reasonable assurance that it is managing federal awards in compliance with federal statutes, regulations and provisions of contracts or grant agreements that could have a material effect on each of its federal programs. Non-federal entities other than states, must follow the procurement standards set out at 2 CFR sections 200.318 through 200.326. Entities must use their own documented procurement procedures, which reflect applicable state and local laws and regulations, provided that the procurements conform to applicable federal statutes and the procurement requirements identified in 2 CFR part 200. A non-federal entity must use the micro-purchase and small purchase methods only for procurements that meet the applicable criteria under 2 CFR sections 200.320(a) and (b). Micro-purchases may be awarded without soliciting competitive quotations if the non-federal entity considers the price to be reasonable (2 CFR section 200.320(a). If small purchase procedures are used, price or rate quotations must be obtained from an adequate number of qualified sources (2 CFR section 200.320(b)). Non-federal entities are prohibited from contracting with or making sub-awards under covered transactions to parties that are suspended or debarred. ?Covered transactions? include contracts for good and services awarded under non-procurement transaction that are expected to equal or exceed $25,000 or meet certain other criteria as specified in 2 CFR section 180.220. Corrective Actions Taken or Planned: Recently we implemented and communicated a revised Procurement policy that reinstates the requirement of 3 competitive bids if the requisition amount is over $10K. NSC will ensure reinforcement of this policy through multiple layers of review (Legal, Accounting and Executives). Although, the policy was recently reinstated NSC will ensure that it will abide to the policy as much as is possible for all purchases prior to November 1st. In order to facilitate and implement the new procurement policy, NSC will utilize ERP system AVID which helps create approval routings through automated workflows. Accounting, Legal and up to the VP level will ensure and review proper documentation. The CFO and COO will be the final line of review prior to ultimate approval for all purchases above the VP delegation level of authority. The following approvals are required for procurements for items up to: 15K by VP?s of business units 50K by CFO, 100K by COO, Over $100K by CEO. A thorough review of Federal grants will be performed and a new standard operating procedure created, to ensure that all federal ruled are properly being followed as part of the procurement policy. Finally, multiple training sessions and communications to all affected staff will be conducted in order to ensure future compliance at all levels. Anticipated completion date: October 27th 2022 Individual Responsible: Ron Hausner, CFO
Contact Person - Paul Grams, Superintendent. Corrective Action Plan - The District will review their procedures to ensure that all expenditures are eligible expenditures. Completion Date - January 31, 2023.
Contact Person - Paul Grams, Superintendent. Corrective Action Plan - The District will review their procedures to ensure that all expenditures are eligible expenditures. Completion Date - January 31, 2023.
2022-001 INADEQUATE SEGREGATION OF DUTIES Actions Planned ? The Authority is not in position to hire additional staff members for the sole purpose of eliminating the ?segregation of duties? finding from our audit. The Airport Office Administrator communicates with the Executive Director and com...
2022-001 INADEQUATE SEGREGATION OF DUTIES Actions Planned ? The Authority is not in position to hire additional staff members for the sole purpose of eliminating the ?segregation of duties? finding from our audit. The Airport Office Administrator communicates with the Executive Director and commission members regarding all major account transactions, including the recording of recurring and non-recurring journal entry adjustments. The commission meets monthly and closely monitors the financial information provided to them. Official Responsible ? Airport Office Administrator Planned Completion Date ? On-going monitoring Disagreement with Finding ? None ? The Authority concurs with the finding. Plan to Monitor ? The Authority is aware of the situation and will monitor, as it deems appropriate. Monitoring will include commission member oversight for the interim and year-end reporting.
AGING CLUSTER ? Assistance Listing No. 93.AGING Recommendation: We recommend the Council review its payroll procedures over hourly employees to ensure all hours are properly accounted for by pay code in the final payroll. Explanation of disagreement with audit finding: There is no disagreement with ...
AGING CLUSTER ? Assistance Listing No. 93.AGING Recommendation: We recommend the Council review its payroll procedures over hourly employees to ensure all hours are properly accounted for by pay code in the final payroll. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Fiscal staff will review timesheet formats and search for possible improvements to the existing templates. Since this incident occurred, the Council has split the former Fiscal Coordinator position into two separate roles. This allows each employee to spend additional time on a fewer number of employees during payroll and review each timesheet with a high level of detail. Fiscal staff will continue to focus on precautions to reduce risk of error and employees will be encouraged to review their paystubs after each pay period. Name(s) of the contact person(s) responsible for corrective action: Becky Walter, Fiscal Manager Planned completion date for corrective action plan: December 31, 2023
Community Development Block Grants ? Assistance Listing No. 14.228 Recommendation: We recommend that the Council record federal expenditures on the SEFA under the program in the year upon which the loan disbursement occurs. Explanation of disagreement with audit finding: There is no disagreement wit...
Community Development Block Grants ? Assistance Listing No. 14.228 Recommendation: We recommend that the Council record federal expenditures on the SEFA under the program in the year upon which the loan disbursement occurs. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Council has revised their procedures so that loan disbursements will be recorded on the SEFA in the year in which they are disbursed. Name(s) of the contact person(s) responsible for corrective action: Anita Cameron, NLF Director, and Becky Walter, Fiscal Manager Planned completion date for corrective action plan: December 31, 2023
Community Development Block Grants ? Assistance Listing No. 14.228 Recommendation: We recommend preparing the required reports under the CDBG program to be ready for uploading to the portal once it is accessible to ensure reporting requirements are met. Explanation of disagreement with audit finding...
Community Development Block Grants ? Assistance Listing No. 14.228 Recommendation: We recommend preparing the required reports under the CDBG program to be ready for uploading to the portal once it is accessible to ensure reporting requirements are met. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Program Director will work with the Fiscal Office to ensure all reporting requirements are met prior to the deadline, regardless of ability to submit. This plan will ensure past, current, and future reporting requirements are met. Name(s) of the contact person(s) responsible for corrective action: Anita Cameron, NLF Director and Becky Walter, Fiscal Manager Planned completion date for corrective action plan: December 31, 2023
Finding 35396 (2022-004)
Significant Deficiency 2022
2022-004 Reporting Requirements for Federally Funded Projects - U.S. Department of Treasury Coronavirus State and Local Fiscal Recovery Funds, (Assistance Listing #21.027). Name of Contact Person Responsible...
2022-004 Reporting Requirements for Federally Funded Projects - U.S. Department of Treasury Coronavirus State and Local Fiscal Recovery Funds, (Assistance Listing #21.027). Name of Contact Person Responsible for Correction Action Plan: Sean Townsend, County Administrator Corrective Action Plan: The county has adopted a new Grant policy and procedures to ensure timely and accurate grant submissions. Anticipated Completion Date: Fiscal year 2023.
Finding 35395 (2022-002)
Significant Deficiency 2022
See Corrective Action plan for chart/table
See Corrective Action plan for chart/table
2022-003 Health Centers Cluster ? Assistance Listing No. 93.224 and 93.527 Recommendation: Management should consider increasing the frequency of its self-reviews of patient encounters or expanding its sample sizes in addition to providing additional training for front desk staff regarding the col...
2022-003 Health Centers Cluster ? Assistance Listing No. 93.224 and 93.527 Recommendation: Management should consider increasing the frequency of its self-reviews of patient encounters or expanding its sample sizes in addition to providing additional training for front desk staff regarding the collection and verification of patient information for each patient. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: 1) Expired sliding fee application Design, implement, and review a monthly report to ensure that the appropriate employees are making the Financial Assistance (FA) and Sliding Fee Discount Program adjustments. Every 2 months ? internal audits of FA and Self Pay patient accounts will be completed and documented. Additional training will be completed and documented for all Revenue Cycle Team members. We will review Discount Program along with Financial Assistance policies and procedures and discuss our financial policy related to ? Sliding Fee Scale. 2) Incorrectly assigned discount due to brief variation in sliding fee tables to expand the number of patients eligible to receive discounts. Heartland?s policies and procedures clearly reflect that the sliding fee scale discount program will only be extended to eligible patients up to 200% of the federal poverty guidelines. The Revenue Cycle Manager and CFO will ensure on a every 2-month basis that no slides will be given to ineligible patients based on income and family size. This monthly review will be documented, approved, and filed by fiscal year. Name(s) of the contact person(s) responsible for corrective action: Michael Cohlman, CFO and Katie Saucedo, Revenue Cycle Manager Planned completion date for corrective action plan: 4/1/23
2022-002 Health Centers Cluster ? Assistance Listing No. 93.224 and 93.527 Health Center Infrastructure Support ? Assistance Listing No. 93.526 Recommendation: Management should adhere to or revise the Organization?s existing procurement policy and implement a system of processes and internal cont...
2022-002 Health Centers Cluster ? Assistance Listing No. 93.224 and 93.527 Health Center Infrastructure Support ? Assistance Listing No. 93.526 Recommendation: Management should adhere to or revise the Organization?s existing procurement policy and implement a system of processes and internal controls to ensure that the appropriate level of documentation is maintained based on the procurement methodology selected for a transaction of contract. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: 1) Procurement ? missing documentation for sole source purchase justification or price comparisons. Heartland?s purchasing policies and procedures were reviewed for content and clarity. In addition to the policy and procedure review, we will implement a more robust documentation, review, and approval process regarding larger purchases and sole sourcing. Purchases that are grant related and > $2,500 where the 3 bid minimum decision-making process is being waived and sole source is being utilized will be documented by the purchasing manager and reviewed, approved, and signed by our CEO as to why this is the optimal vendor (1). (See attached template) 2) Suspension and Debarment- missing documentation for quarterly review of vendors. Vendors will be reviewed on a quarterly basis to ensure that they are not on the exclusion list. The Accounting Specialist will report to the Controller on a quarterly basis regarding the status of the vendor review, and documentation of the review will be provided to the Controller at that time. Name(s) of the contact person(s) responsible for corrective action: Michael Cohlman, CFO and Tony Bartlett, Controller Planned completion date for corrective action plan: 4/1/23
The District?s finding for not having adequate internal controls for ensuring compliance with wage rate requirements was solely because the district did not know about the federal requirement to monitor all certified payrolls paid by the contractors who provided the portable to the vendor the Distri...
The District?s finding for not having adequate internal controls for ensuring compliance with wage rate requirements was solely because the district did not know about the federal requirement to monitor all certified payrolls paid by the contractors who provided the portable to the vendor the District purchased from. Upon learning that the District is required to monitor certified payrolls paid by contractors and subcontractors who provide products to our vendors, the District will request certified payrolls from our vendors ensuring prevailing wages are paid from any corresponding contractor and subcontractor prior to final payment.
1. Excess indirect cost billing Three contracts identified with excess indirect cost billing will be corrected on the next invoice and prior to contract ending date. Assistance Listing (AL) No. 93.268 or 2103 CBO Contract and No. 93.391 or 2103 Health Equity Contract are ending by November 2023 and ...
1. Excess indirect cost billing Three contracts identified with excess indirect cost billing will be corrected on the next invoice and prior to contract ending date. Assistance Listing (AL) No. 93.268 or 2103 CBO Contract and No. 93.391 or 2103 Health Equity Contract are ending by November 2023 and May 2024 respectively. Hawaii Public Health Institute (HIPHI) will submit up to date billing with corrections. As recommended by the auditors, the HIPHI team will 1) create a written procedure that describes in detail the process to prepare and review program billings, and 2) implement guidelines on how to record indirect costs. For all federally awarded programs, the Director of Finance and Operations and the program's lead manager, with direct knowledge of the requirements for the grants, will review the billing prior to submission to the funder. The Finance and Accounting Manager and/or other trained Finance and Operations staff will prepare the billings, provide financial reports as requested, and include any supporting documentation used, for the reviewers.
View Audit 28427 Questioned Costs: $1
We plan to hire a new individual in the Finance Department who is a level below myself and give the responsibility of the preparation of the PRF, so that I can be the reviewer of the PRF report to ensure that it is accurate.
We plan to hire a new individual in the Finance Department who is a level below myself and give the responsibility of the preparation of the PRF, so that I can be the reviewer of the PRF report to ensure that it is accurate.
Finding 35377 (2022-005)
Significant Deficiency 2022
ELIGIBILITY Recommendation: The County should implement additional procedures to provide reasonable assurance that necessary documentation is properly input in MAXIS. Case file reviews should be performed. Explanation of disagreement with audit finding: There is no disagreement with the audit findin...
ELIGIBILITY Recommendation: The County should implement additional procedures to provide reasonable assurance that necessary documentation is properly input in MAXIS. Case file reviews should be performed. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned in response to finding: Supervisor will sample and perform a quality review on a quarterly basis to ensure case workers are accurately assessing eligibility. Review will be documented. Supervisor will review at least 1 casefile for each caseworker per quarter and randomly pull additional cases from new caseworkers. Name of the contact person responsible for corrective action: LoAnn Shepard, Eligibility Supervisor Planned completion date for corrective action plan: December 31, 2023
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