Finding 1205097 (2025-003)

Material Weakness Repeat Finding
Requirement
C
Questioned Costs
-
Year
2025
Accepted
2026-03-31

AI Summary

  • Core Issue: There are significant delays in submitting reimbursement requests for expenditures, leading to potential duplicate requests and compliance risks.
  • Impacted Requirements: Compliance with 2 CFR 200.302 and 200.303 regarding timely accounting and internal controls over federal awards is not being met.
  • Recommended Follow-Up: Implement reconciliation procedures for legacy drawdown requests and establish ongoing controls to ensure accurate and complete records in the new electronic system.

Finding Text

Finding Number - 2025-003 Cash Management; Allowable Costs Federal Agency Department of Health & Human Services Federal Program Epidemiology and Laboratory Capacity for Infectious Diseases ALN 93.323 Grant Number Various Compliance Requirement Cash Management / Unallowable Costs Type of Findings Internal Control over Compliance / Compliance Category Significant Deficiency Criteria 2 CFR 200.302 states that each state must expend and account for the Federal award in accordance with state laws and procedures for expending and accounting for the state's own funds. In accordance with 2 CFR §200.303, non-federal entities are required to establish and maintain effective internal control over federal awards to ensure compliance with federal statutes, regulations, and the terms and conditions of the award. Such controls should include procedures to ensure expenditures are timely identified and included in reimbursement requests. Section III- Findings and Questioned Costs Relating to Federal Awards – (continued) Finding Number - 2025-003 Cash Management; Allowable Costs – (continued) Condition During our testing of expenditures charged to the Epidemiology and Laboratory Capacity (ELC) program, we identified instances in which expenditures incurred and paid during fiscal year 2022 were included in reimbursement requests submitted during 2025. Although the expenditures appear to relate to allowable program activities, the significant lapse of time between the payment date and the reimbursement request indicates weaknesses in the monitoring and tracking of expenditures pending reimbursement. Also, because the expenditures were originally incurred and paid in 2022, and supporting documentation for prior reimbursement requests was not readily available for the period under audit, we were unable to determine whether these costs had been previously requested for reimbursement. Drawdown No. Type Receipt Date Document No. Check Issuance Date Amount 1525250884 Reimbursement 11-Apr-25 426878 7/21/2022 $ 491,400 428005 8/25/2022 249,960 428049 8/25/2022 558,600 433231 10/11/2022 525,000 440140 11/7/2022 211,803 440145 11/7/2022 248,660 440156 11/7/2022 204,941 429703 6/24/2022 767,102 435438 8/12/2022 745,039 447617 12/8/2022 211,312 $ 4,213,817 Cause Management explained that, in prior periods, drawdown requests were processed manually and on an advanced basis. Subsequently, the Department implemented an electronic system to submit drawdown requests and transitioned the process to a reimbursement method. As part of this transition, certain advance requests that had been processed manually were not properly cleared in the new system and remained recorded as if they had not been requested. Because these requests appeared as pending in the system, they were later submitted again through the new reimbursement process, resulting in duplicate requests in the system records. Section III- Findings and Questioned Costs Relating to Federal Awards – (continued) Finding Number - 2025-003 Cash Management; Allowable Costs – (continued) Effect As a result, these requests appeared as outstanding in the electronic system and were later submitted again through the reimbursement process. This situation created duplicate drawdown requests in the system records and increased the risk of misstated drawdown activity and potential over-requesting of federal funds if not properly identified and reconciled. Questioned Costs None Perspective Information During our procedures, management explained that prior to the implementation of the current electronic drawdown system, requests for federal funds were submitted manually on an advanced basis. Subsequently, the Department implemented an electronic system to process drawdown requests and transitioned the funding methodology from advances to a reimbursement basis. As part of this transition, certain drawdown requests that had already been submitted manually were not properly cleared or recorded in the new system and remained reflected as pending. Prior Year Audit Finding This is not a repeat finding. Recommendation We recommend that management implement procedures to reconcile manual drawdown requests processed prior to the implementation of the electronic system with the transactions recorded in the system. In addition, management should conduct a comprehensive and detailed review of all legacy transactions that originated before the system transition to ensure that any requests previously processed manually are properly identified, cleared, and supported by adequate documentation. This review should be performed with heightened scrutiny to detect any duplicate or unreconciled drawdown requests. Furthermore, management should establish ongoing controls to periodically review outstanding balances in the system and ensure that all drawdown records are accurate, complete, and appropriately supported. Section III- Findings and Questioned Costs Relating to Federal Awards – (continued) Finding Number - 2025-003 Cash Management; Allowable Costs – (continued) Views of Responsible Officials and Planned Corrective Actions The PRDH’s management agrees with this finding. Please refer to the corrective action on pages 57-60.

Corrective Action Plan

The PRDOH agreed with the findings and is working with the Finance Department to establish and strengthen our internal controls to ensure all payments comply with the guidelines established by the Federal Government. On the other hand, PRDOH is working and verifying our written procedures to ensure that payments are issued promptly after the drawdown is made.

Categories

Cash Management Allowable Costs / Cost Principles

Other Findings in this Audit

  • 1205098 2025-004
    Material Weakness Repeat
  • 1205099 2025-005
    Material Weakness Repeat
  • 1205100 2025-006
    Material Weakness Repeat
  • 1205101 2025-007
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $4.40B
10.557 Special Supplemental Nutrition Program for Woman, Infants and Children $211.52M
93.767 Medicaid-Children's Health Insurance Program (CHIP) $56.81M
93.323 COVID-19 Epidemiology and Laboratory Capacity $32.90M
66.468 Fund of Drinking Water $29.69M
93.994 Maternal and Child Health Services Block Grant to the State $12.98M
93.268 Immunization and Vaccines PPHF $11.73M
93.323 Epidemiology and Laboratory Capacity $8.19M
93.940 Integrated HIV Surveillance And Prevention Programs $8.10M
93.967 COVID-19 Strengthening US Public Health $5.60M
93.069 Public Health Crisis Response $5.16M
84.181 Special Education - Grant for Infants and Families $3.21M
97.036 Hurricane Maria $3.19M
93.255 Children's Hospitals Graduate Medical Education Payment Program $2.83M
93.354 COVID-19 Workforce Supplementary Funding $2.60M
93.391 COVID-19 Health Disparities $2.46M
93.917 HIV Care Formula Grants $2.41M
93.991 Preventive Health Services Block Grant $2.29M
93.889 National Bioterrorism Hospital $2.22M
93.967 Strengthening US Public Health $1.62M
93.235 State Sexual Risk Avoidance Education $1.32M
93.977 PRDOH Strengthening STD Prevention And Control $1.22M
93.791 Money Follows Person Rebalance $1.06M
93.377 Prevention & Control Of Chronic Disease And Associated Risk Factor In PR $1.04M
93.870 ACA-Maternal Infant and Early Childhood Home Visiting $1.02M
93.136 PR Overdose Data to Action $959,187
66.432 State Public Water System Supervision $916,745
93.777 Health Insurance Benefits Program $886,201
93.136 PR Comprehensive Suicide Prevention $801,744
93.977 COVID-19 PRDOH Strengthening STD Prevention And Control $591,450
20.607 Alcohol Toxicology Laboratory $583,518
93.889 Hospital Preparedness Program $485,243
93.136 PR Sexual Violence Prevention and Education $479,905
93.008 National Association of County and City Health Officials $478,869
93.998 Puerto Rico Autism and Development $464,678
93.243 PR Broad-Based Approach to Suicide Prevention in Adults $458,509
93.336 PR BRFSS Surveillance System $449,385
93.777 Clinical Laboratory Services $431,958
93.270 Integrated Viral Hepatitis Surveillance and Prevention Program $390,286
93.092 Affordable Care Act (ACA) Personal Responsibility Education Program $375,665
93.197 PR Childhood Lead Poisoning $355,179
93.944 Medical Monitoring Project $344,694
93.354 Public Health Crisis Response $335,816
93.944 HIV Care Formula Grants $331,205
93.116 Puerto Rico Tuberculosis Program $298,354
93.870 COVID-19 American Rescue Plan Act Funding $297,406
93.946 PR Maternal Mort Rev Committee Deaths Prevention $256,437
93.354 PHER-Monkey Pox $218,238
93.251 Universal Newborn Hearing Screening $217,564
93.946 PR - Pregnancy Risk Assessment Monitoring System $151,238
93.130 State Primary Care Offices $132,615
93.334 Alzheimer Disease PR $125,375
93.314 Enhancement of the EHDI-is for Documentation and use of $119,056
93.497 Administration for Families and Children (ADFAN) $109,441
93.940 Ending HIV Epidemic in SJ $98,627
93.110 Promotion Administration State Stable - Help Center for Rape Victims $95,957
93.387 Optimize PRQ Tabacco Education $88,333
14.241 Housing Opportunities for Persons with AIDS $72,554
93.945 Social Determinants of Health $60,177
93.734 Prevention & Control Of Chronic Disease And Associated Risk Factor In PR $40,743
93.048 Promotion of Independence Living $19,936
93.777 IMPACT Award $12,148
93.354 COVID-19 Public Health Crisis Response $11,933
97.036 Hurricane Irma $1,250
93.070 Puerto Rico Comprehensive Public Health Approach to Asthma Control $0
93.136 COVID-19 PR Sexual Violence Prevention and Education $-5,292
93.268 COVID-19 Immunization and Vaccines PPHF $-21,538
97.036 COVID-19 Pandemic $-875,721
93.778 COVID-19 Medical Assistance Program $-3.26M