A long-anticipated performance audit of the North Dakota State Auditor’s Office found no significant issues, consultants told a panel of lawmakers Thursday afternoon.

“Based on the work that we performed, there weren’t any red flags,” Chris Ricchiuto, representing consulting firm Forvis Mazars, said.

The review was commissioned by the 2023 Legislature following complaints from local governments about the cost of the agency’s services.

The firm found that the State Auditor’s Office is following industry standards and laws, and is completing audits in a reasonable amount of time, said Charles Johnson, a director with the firm’s risk advisory services.

“The answer about the audit up front is that we identified four areas where things are working exactly as you expect the state auditor to do,” Johnson told the committee.

The report also found that the agency has implemented some policies to address concerns raised during the 2023 session.

For example, the Auditor’s Office now provides cost estimates to clients before they hire the office for services, Johnson said. The proposals include not-to-exceed clauses, so clients have to agree to any proposed changes.

The State Auditor’s Office also now includes more details on its invoices, so clients have more comprehensive information about what they’re being charged for.

The audit originally was intended to focus on fiscal years 2020 through 2023. However, the firm extended the scope of its analysis to reflect policy changes that the Auditor’s Office implemented after the 2023 fiscal year ended.

State Auditor Josh Gallion told lawmakers the period the audit covers was an unusual time for his agency. The coronavirus pandemic made timely work more difficult for his staff. Moreover, because of the influx of pandemic-related assistance to local governments from the federal government, the State Auditor’s Office’s workload increased significantly.

Gallion said that, other than confirming that the changes the agency has made were worthwhile, he didn’t glean anything significant from the audit.

“The changes had already been implemented,” he said.

Gallion has previously called the audit redundant and unnecessary. When asked Thursday if he thought the audit was a worthwhile use of taxpayer money, Gallion said, “Every audit has value, at the end of the day.”

The report has not been finalized, though the Legislative Audit and Fiscal Review Committee voted to accept it.

Audit of state auditor delayed; Gallion calls it ‘redundant, unnecessary’

“There was no shenanigans, there were no red flags,” Sen. Jerry Klein, R-Fessenden, said at the close of the hearing.

Forvis representatives told lawmakers they plan to finish the report sometime this month.

The contract for the audit is for $285,000.

Johnson said as far as he is aware Forvis has sent bills for a little over $150,000 so far. That doesn’t include the last two months of the company’s work, he said.

The consulting firm sent out surveys to local governments that use the agency’s services.

The top five suggestions for improvements were:

• Communication with clients
• Timeliness
• Helping clients complete forms
• Asking for same information more than once
• Providing more detailed invoices

The top five things respondents thought the agency does well were:

• Understanding of the audit process
• Professionalism
• Willingness to improve
• Attention to detail
• Helpfulness

Johnson said that some of the survey findings should be taken with a “grain of salt.”

“In our work as auditors, we don’t always make people happy doing what we’re supposed to do,” he said.

BISMARCK — A bill introduced in the North Dakota House of Representatives could cap out-of-pocket insulin costs for some North Dakotans at $25 per month.

The bill also includes a monthly cap for insulin-related medical supplies of $25.

With insulin costing North Dakota residents billions of dollars each year,

House Bill 1114

would provide relief for people on fully insured plans provided by individual, small and large group employers. People on self-funded plans would not be affected.

“I call insulin liquid gold,” Nina Kritzberger, a 16-year-old Type 1 diabetic from Hillsboro, told lawmakers. “My future depends on this bill.”

HB 1114 builds on

legislation

proposed during the 2023 session that similarly sought to establish spending caps on insulin products.

Before any health insurance mandate is enacted,

state law

requires the proposed changes first be tested on state employee health plans.

As such, the legislation was altered to order the state Public Employees Retirement System, or PERS, to introduce an updated bill based on the implementation of a $25 monthly cap on a smaller scale.

The updated bill — House Bill 1114 — would bring the cap out of PERS oversight and into the North Dakota Insurance Department, which regulates the fully insured market but not the self-insured market.

Employers that provide self-insured health programs use profits to cover claims and fees, acting as their own insurers.

Fully insured plans refer to employers that pay a third-party insurance carrier a fixed premium to cover claims and fees.

“It (the mandate) doesn’t impact the entire insurance market within North Dakota,” PERS Executive Director Rebecca Fricke testified during a Government and Veterans Affairs Committee meeting on Thursday, Jan. 9.

Blue Cross Blue Shield Vice President Megan Hruby told the committee that two-thirds of the provider’s members would not be eligible for the monthly cap, calling the bill a “false promise.”

“We do not make health insurance more affordable by passing coverage mandates, as insurance companies don’t pay for mandates. Policy holders pay for mandates in the form of increased premiums,” Hruby said.

She touted the insurance provider having already placed similar caps on insulin products and said companies should be making those decisions, not the state government.

Sanford Health and the Greater North Dakota Chamber also had representatives testify against the bill.

Advocates for the spending cap said higher premiums are worth lowering the cost of insulin drugs and supplies.

“One of the first things that people ask me about is, ‘Why should I pay for your insulin?’ And my response is, ‘Why should I have to pay for your premiums?’” Danelle Johnson, of Horace, said in her testimony.

If adopted and as written, the spending caps brought by

House Bill 1114

would apply to the North Dakota commercial insurance market and cost the state around $834,000 over the 2025-27 biennium.

According to the 2024 North Dakota diabetes report,

medical fees associated with the condition cost North Dakotans over $306 billion in 2022.

The state has more than 57,200 adults diagnosed with diabetes, and a staggering 38% have prediabetes — a condition where blood sugar levels are high but not high enough to cause Type 2 diabetes.

Nearly half of those people are adults 65 years old or older.

North Dakotan tribal members were also found to be twice as likely to have diabetes compared to their white counterparts.

Building international connections is an important aspect of the agricultural industry.

This year, farmer

Rudy Dotzenrod

hosted visitors from the Big Iron International Visitors Program to his farm to showcase his crops and Reinke irrigation systems.

“They were looking for a place to kind of showcase some of their swing-arm technology at the end of their pivots,” Dotzenrod said. “I’ve got a couple of them here, so they wanted to come.”

There were visitors from all of the world, including Turkey, Guatemala and Africa.

“We bring in anywhere from 50 to 150 international visitors every year,” said Lindsey Warner, deputy director of the North Dakota Trade Office. “The goal of that is, first and foremost, have agriculture machinery buyers learn more about North Dakota, our agriculture, our agriculture practices, the machinery that’s manufactured here.”

They got to see every part of the farming operation.

“I took a lot of them, and we walked around the farm, we went to different buildings and we looked at all sorts of different kinds of machinery, you know, from getting the ground ready, to planting, to spraying it, to harvesting it, just kind of looked at everything,” Dotzenrod said.

With Dotzenrod also being a black bean grower, that was beneficial to the visitors from Guatemala.

“They were very interested in irrigation and black beans,” Warner said.

However, most were interested in his corn production.

“I was kind of surprised, I thought there may be a few more questions on edible beans, but it was mostly in corn,” Dotzenrod said.

Bringing international visitors directly onto the farm is a big part of the tour.

“We live in a global world. A lot of the commodities that are produced within our state are exported outside of the U.S., so I think it’s really beneficial for people to see where their food is coming from, whether they are North Dakotas or they are international consumers of these products” Warner said.

“People kind of want to know where their food is coming from, you know, and if they can try and put a face on that or an environment, that gives them a better understanding of where it’s at,” Dotzenrod said. “A lot of this is beyond the economics of it. It’s relationship based. If they feel like they’re buying something from somebody they like, I think it makes it a lot easier for them to go ahead and do that.”