Single Audit Report Fiscal Year Ended June 30, 2012 - State ...

State of GeorgiaFederal Awards Findings and Questioned CostsFor the Fiscal Year Ended June 30, 2012Finding Control Number: FA-405-12-05SPECIAL TESTS AND PROVISIONSInadequate Internal Controls and Noncompliance with Special Tests and ProvisionsImmunization Grants (CFDA 93.268)ARRA IMMUNIZATION (CFDA 93.712)U.S. Department of Health and Human ServicesGrant Awards: Year 2012 - 3H23IP422521-11S1; 6H23IP422521-11Condition:Our examination of the Immunization Grants Cluster program included a review of the QualityAssurance Site Visit documentation that was maintained by the Department of Public Health for 41 of1274 active Vaccines for Children (VFC) providers. The review revealed four (4) instances where therequired site visits were not conducted within the prescribed two (2) year time period and one (1)instance where a follow-up site visit was not conducted to determine if the VFC provider implementeda corrective action plan. In addition, we noted that the Department did not ensure 50 percent of allactive VFC providers received a site visit for the calendar year that ended December 31, 2011 asrequired by the Centers for Disease Control and Prevention (CDC).During our examination we also noted that the procedures performed to monitor VFC provider sitevisits during the year were not adequately documented.Criteria:The Department of Public Health is responsible for administering the State of Georgia’s ImmunizationGrants Cluster program, which is overseen by the U.S. Department of Health and Human Servicesthrough the CDC, and for establishing and maintaining effective internal controls over compliancewith the Special Tests and Provisions requirements for Record of Immunization and Control,Accountability and Safeguarding of Vaccine included in the Office of Management and Budget(OMB) Circular A-133 Compliance Supplement.The CDC requires that 50 percent of all VFC providers receive a site visit on an annual basis, whichmeans that all VFC providers should receive at least one (1) site visit within a two (2) year period.Information: The Department only performed site visits on 39% of the VFC providers during calendar year 2011,which means that the 50% requirement was not met as of December 31, 2011.According to the Department, a new tracking spreadsheet was established in January 2012 to track theperformance of site visits on a monthly basis. The tracking spreadsheet, however, did not provide anyevidence to show how often it was being updated. As the tracking spreadsheet is updated each month,evidence of prior tracking is no longer available since it is over written by the current update.Cause:Effect:Recommendation:The Department’s procedures for documenting VFC provider site visits did not provide evidence thatthe required number of site visits were properly and consistently performed within the prescribedtimeframe.Failure to perform the required number of site visits within the prescribed timeframe resulted innoncompliance with Federal regulations and increases the risk that provider noncompliance, as a resultof not maintaining proper control and accountability for vaccine, properly safeguarding vaccine ormaintaining proper records of immunization for administered vaccines, will not be identified andaddressed in a timely manner.The Department of Public Health should review current policies and procedures for monitoring VFCprovider site visits to determine if they are functioning properly. The Department should establish andimplement additional policies and procedures, as needed, to ensure the required number of site visitsare properly and consistently performed within the prescribed timeframe and adequate documentationof monitoring procedures is maintained.87