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Investigation: Earmarked AIDS funds lack oversight

J'Mia Edwards, AIDS patient and outreach worker
J'Mia Edwards, AIDS patient and outreach worker (Jahi Chikwendiu, The Washington Post)

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Debbie Cenziper
Washington Post investigative reporter
Monday, October 19, 2009; 11:00 AM

In a city whose HIV/AIDS rates are ten times the national average, one in three of D.C.'s AIDS dollars earmarked for local groups in recent years went to organizations cited for falsified documentation, few or no clients, incomplete spending records or not running any AIDS programs whatsoever. Meanwhile, District residents living with HIV/AIDS have struggled to find care.

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Wasting Away: The Squandering of D.C.'s AIDS Dollars

Washington Post staff writer Debbie Cenziper was online Monday, Oct. 19, at 11 a.m. ET to discuss details of the investigation.

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Debbie Cenziper: Good morning and thanks for signing on.

The Washington Post this weekend published the first round of what will become an ongoing investigation about HIV/AIDS funding in the District. The stories found that more than $25 million in recent years was paid to nonprofit AIDS groups racked by problems, including dangerous lapses in care, questionable spending and widespread waste and mismanagement.

Some groups submitted the names of ghost employees and fake consulting contracts. Others listed addresses at places that did not appear to be home to any AIDS agency.

It happened while sick people languished in alleyways and homeless shelters.

I'm looking forward to talking with you this morning about why this happened and where the city goes from here.

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Baltimore: I don't think I've ever read a story that made me angrier. In particular, I want to know how so many people with extensive criminal records got to dip their hands in the till and take money that was intended to help the poorest, most vulnerable citizens of Washington. Why was there no meaningful oversight by the mayor or the City Council? As I said, the story made me angry--but it also made me proud of the Post for committing to such an important investigative enterprise.

Debbie Cenziper: Hi Baltimore. Thanks for your note. The D.C. Inspector General's Office has twice published reports that talked about a chronic lack of oversight at the HIV/AIDS Administration, and D.C. Council member David Catania has held hearings. What happened after that? Good question. There's been very little follow-up and no accounting of any money. I tried calling the mayor's office before the series ran, but did not hear back. I did, however, speak to the D.C. Attorney General. We'll see what happens.

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Washington, DC Ward 6: Debbie, will this expose' into waste, fraud and abuse of HIV/AIDS grant funding extend to larger local health care providers (i.e. Whitman Walker)considering their very public allegation of poor management by Councilman David Catania? If not, why not? Said another way, can we expect your report to be balanced or one sided?

Debbie Cenziper: Good question. There was a lot of money to track -- it took ten months to vet 90 smaller AIDS nonprofits in the city.

As the stories this weekend noted, we intentionally left out the larger medical clinics.

However, that's a top priority on The Post's agenda.

If anyone has a tip on that front, please give me a call.

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Washington, DC: Why hasn't the city taken action to prosecute those inside and outside the government who defrauded taxpayers and violated their public duty?

Debbie Cenziper: I'm getting lots of questions about why the city hasn't stepped up on this front.

I think the city believes that most of the problems were in the past (2004 to 2008) and that under the new mayor and the new head of the HIV/AIDS Administration, Dr. Shannon Hader, much work has been done in the past year to bring more accountability to the system.

Unfortunately, that's not what we're seeing on the streets, or hearing among local AIDS groups. Some of the most troubled AIDS groups, in fact, were until recently still being funded. And there has been little or no investigation on the now-defunct groups that we featured in this weekend's stories.

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Washington, DC: Hi -- great article (though very frustrating to see how our tax dollars are squandered!).

Have you had any response/reaction from the DC government? How do they plan to remedy the situation? Unfortunately, I feel like things will change for a little bit, but will inevitably go back to status quo.

Debbie Cenziper: Here's another one...

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Silver Spring, Md.: How has HUD responded to the allegations of misuse of HOPWA dollars?

Debbie Cenziper: Also a good question.

When I've reported HUD-related abuses in the past, HUD usually says that it's up to the local agency -- in this case, D.C.'s HIV/AIDS Administration -- to monitor its grants and the local providers.

I think I saw a couple of HUD reports talking about the lack of oversight of local AIDS groups in D.C., but nothing specific from that agency.

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Washington , DC: How large is the AIDS office in DOH? Are there too many staff and too large a bureaucracy that nothing gets done, or issues don't get resolved? Does the bureaucracy diffuse responsibility?

Debbie Cenziper: This is an interesting question.

I think the answer is that year after year, the city cut checks but didn't bother to make sure that AIDS money was trickling down to the people who needed it. I don't think it was an issue of the size of the bureaucracy -- it was just the way things had always been done, year after year, as sick people struggled.

Monitors from the HIV/AIDS Administration focused heavily on whether groups were spending enough money -- not whether the spending was legitimate.

The city says that's changing. But one of the most troubled groups, Hill's Community Residential Support Services, was until recently still being funded. Monitors at the HIV/AIDS Administration found last February that documents appeared to be fake and that people with AIDS in the program were living in dangerous conditions. What does it take to close a program down?

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Houston, Tex.: If I waste thousands of dollars at my work, I would get fired. Somebody wasted hundreds of thousands of dollars at their work. Somebody working for D.C. is responsible for approving this waste. The buck stops somewhere. When will names be tied to this waste? When will they be punished? And when will the taxpayers be notified? Beyond the tragedy of sick people not receiving the help they need, the people responsible for this waste will continue wasting funds because there is no accountability in government. Waste and incompetence are routinely overlooked, and even promoted. Heads should roll. Instead, bonuses all around.

Debbie Cenziper: Interesting point.

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Washington, D.C.: Debbie, thank you and your colleagues so much for your herculean labors on this story. I suspect that most readers will find the subject too bleak to deal with, but please know that there are still many of us who value this kind of in-depth investigative journalism.

Two questions: Have you heard anything from Mayor Fenty in response yet? And how many months (or years) of research went into the story?

Debbie Cenziper: Thanks for your note.

It took ten months to report and write this series. A lot people stepped up to talk publicly about what has been known on the streets for years. I give them credit for that.

I tried calling the mayor's office before publication, but did not get a call back. Will there be any accountability here? I honestly don't know.

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Washington, DC: I have lived in DC for all my life and have been HIV+ for 13 years. I have been unemployed since Mar 2009 and have been collecting unemployment benefits. However, once my benefits end, I stand to be homeless if I can't find a job. This article shed new light that I might have to consider death as an option if I can't find a job or housing voucher. Question: How are these operating agencies prepared to help persons such as myself? How do you get a list of each agency and what they do for person with HIV+ only, so I don't waste my time? Last, do I tell the HIV & AIDS Administration what matters to me the most is housing and food and not massage therapy or acupuncture services? Furthermore, where is the job help for those with disabilities?

Debbie Cenziper: Thanks so much for writing in.

As you know better than I do, housing for people with AIDS is in short supply, with more than 400 people on a years-long waiting list.

I don't have a great answer, unfortunately. There's a current list of HIV providers linked on The Washington Post's website, and some of those groups provide housing and job-training.

I hope you have a good case manager who can try to link you to these services.

Good luck, and take care.

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Follow up on Houston Tex's comment: Will the Post's findings have any impact on Fenty's reelection campaign?

Maybe his office should spend less time worrying about baseball tickets and more on making sure DC government agencies are operating properly and are being held accountable.

Debbie Cenziper: Thanks for writing in.

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Vienna, Va.: I was inspired by your story to try to help this crisis. In your reporting did you find any reputable organizations that you feel comfortable recommending? Someplace where I can donate and volunteer?

Debbie Cenziper: Hi Vienna. Thanks for your note.

There are most certainly some caring, reputable groups out there. We featured one quite prominently called Joseph's House, an AIDS hospice in Northwest Washington. We also wrote about Miriam's House and The Women's Collective.

These are groups that have had to cut salaries, trim back programs or even move into cheaper offices because they can no longer make ends up.

As a reporter, one of the most moving experiences I've had in recent years was attending a memorial service at Joseph's House. More than 300 people have lived and died there since 1990.

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DC: Great series so far. For those of us who make charitable contributions in this area, though, we also need to know which organizations are well managed and make good use of theirs funds so that we can channel our contributions to best service providers. I hope the series will end with at least a list of the groups you found to be fiscally responsible.

Debbie Cenziper: Thanks for your note.

As I mentioned above, there are clearly some more reputable groups out there -- true believers who are in the trenches trying to help.

We wrote about The Women's Collective, Joseph's House, Miriam's House, Metro TeenAIDS and Transgender Health Empowerment. There are others as well.

Please keep reading. We have more stories coming.

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Washington, DC: What is the City going to do? I really don't see the the City doing anything in schools, neighborhoods, or any campaigns to stem the spread of HIV. I see nothing compared to the infection rate.

Debbie Cenziper: I know there's been a lot of talk in the community about the Administration's perceived lack of response to the AIDS crisis in the city.

I'm not sure how the city will move forward at this point.

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Fairfax, Va.: I was a grants manager for four years at the HIV/AIDS administration. The grant monitoring staff have often been unfairly maligned for not paying close enough attention to deficiencies of the nonprofits they were monitoring. From my experience, the fault was with management. Our staff often apprised management of suspected or outright abuses, but we were not given the authority to take any action.

Debbie Cenziper: I think you're right, and that's exactly what the stories pointed out.

I know the Inspector General in the past has pointed to a lack of monitoring. We found that as well in some cases.

But we also found case after case of documented deficiencies that were overlooked by top managers, even in recent months.

Thanks for writing in, and please feel free to give me a call if you'd like to talk specifically about this.

My number is: 202-334-6107.

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Washington, D.C.: Shouldn't government agencies(such as the D.C. HIV/AIDS Administration) who oversee the distribution of federal funds be required to publish the following information 1) the name of the entities/organizations who receive awards, the amount of the awards received by entities, and information on the purpose of the awards, as required under the Federal Funding Accountability and Transparency Act of 2006 (FFATA)?

Debbie Cenziper: You would think so, but the HIV/AIDS Administration has historically struggled to accurately track its funding. We looked at detailed records for about 60 local AIDS groups. I don't think we found a single case where records were intact. AIDS groups are supposed to submit monthly and year-end reports about their clients and services, but we found those reports were often missing. So were budgets, audits, employee resumes, and basic "assurance" paperwork such as business licenses.

The paperwork trail seems to be getting better under the new Administration, however. But there are still many lingering questions about oversight of these groups.

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Clearwater, Fla.: It is shameful to admit that they have needy patients as far back as 2003 that have not been given proper housing or medical care. Many still don't have a case manager, no matter how sick they are with AIDS. Why create invisible records to boost their intake dollars, if they have un-cared for people still on the books since 2003 ? A job center was funded and built and three years later, no one has gotten a job. This is telling me and everyone else that the organization is run by crooks and thieves. Without honesty in the upper level of the organization, they may as well close the place and spend the money feeding and clothing the birds, as AIDS patients get no priority, no matter how sick they are. HONESTY IS THE ONLY ANSWER FOR ALL GOVERNMENT FUNDED ORGANIZATIONS, IF THEY ARE TO ACCOMPLISH THEIR GOALS.

Debbie Cenziper: I hear your frustration.

I've talked to many, many people in the city's AIDS networks in recent months and they are just as frustrated.

When case managers call to try to find housing or job-training for their clients, they are turned away. They ask: How can people stay healthy when they don't have a place to live or no means to support themselves?

This is happening in a city that receives about $100 million a year in AIDS funding.

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DC: I spent many years working in HIV and while I applaud your story, I also have to applaud the workers out there who are trying to make a difference. It can be incredibly draining working to try and change people's behavior, in a system that has piecemeal funding streams where money can be used for this and not for that, where politics trump public health policy and where most people still view HIV as either gay and substance abuse (i.e. deserve it) or innocent victim. Sorry rant there.

The point is, there are some organizations out there doing a great job, with limited resources both financial and otherwise and I'm giving them a shout out. Keep up the hard work.

Debbie Cenziper: I'm so glad you wrote in.

There are many, many people doing good work, both in and outside the HIV/AIDS Administration.

Our goal was to point out how waste, misspending and questionable alliances have impacted the groups that are really trying to help.

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Washington, D.C.: Government contracting at its' worst. Contract performance evaluations are supposed to detect the misapplication of dollars awarded - with a combination of detailed cost reporting and detailed monthly status reporting.

I've always felt that whenever taxpayer dollars are transferred to a business; an executive compensation and responsibilities clause should be inserted. Incentives should be towards meeting contracted obligations; otherwise penalties should target taxpayer reimbursement from those in executive and management positions.

Debbie Cenziper: Interesting point.

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Washington, D.C.: I am completely OUTRAGED! I am desperately trying to volunteer, work and do research in HIV/AIDS housing and no one will as much help me with this and you have organizations squandering money away and people who are NOT receiving the care and supportive services they need! I am living with HIV and I and receiving my graduate degree and completing my thesis in affordable housing and supportive services and I can't as much get a call back because I don't qualify or have the "skills" needed for these types of jobs? So what skills do you need when you have organizations that are clearly NOT helping us in any way shape or form? I deserve and demand answers about this and I'm tired of the District not doing anything to protect us! If not for me...after I die for those that will come after me.

Debbie Cenziper: Wow. I can understand why you are frustrated. I know that many groups really rely on their volunteers. I hope you find a job, and take care.

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Grand Prairie, Tex.: The fraud, abuse, and waste typifies what Americans fear in the current health care debacle - government cannot oversee one the most important aspects of our lives - our health care. I have seen first-hand how non-profits steal money, commit fraud, and basically make the board members and "employees" wealth - all at the expense of those it is meant to help. Criminal activity hiding behind grants/initiatives/TAX DOLLARS.

Debbie Cenziper: I am hearing a lot of this. I'll stay out of this one.

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Anonymous: Given the context of how this city wide program is supposed to be managed by the gov't, please explain to us how the gov't will be managing the health care of our entire nation better?

Debbie Cenziper: One more...

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NYC, NY: Thanks for your efforts to shed light on this important crisis. I would be interested in an in depth piece on the current status, plans and funding for DC's HIV response in the coming 1-3 years. Any chance you could build on your story with a forward looking piece?

Debbie Cenziper: Yes, we have more stories. Please keep reading.

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Annandale, Va.: This just shows how many callous and unempathetic people there are in our society.

Taking candy from babies, money meant for sick is just despicable.

We have tougher penalties for hate crimes maybe these folks when convicted should be have longer sentences too.

Debbie Cenziper: Thanks for writing in. We've been getting a lot of comments like this one.

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Arlington, Va.: Do you sense part of the problem is the reliance on organizations run by/staffed by PWAs (People with AIDS) that are considered more grassroots? In the early days of the epidemic, most AIDS services were provided by agencies run by people with significant experience running organizations and working in the non-profit sector. As the demographics of the epidemic changed, the experience of PWAs who had experience running million-dollar organizations also seemed to change.

I noticed, for instance, that none of the organizations you focused on were organizations geared towards serving the LGBT community or had long experience in providing HIV/AIDS services.

Debbie Cenziper: There has definitely been a push to bring in more start-up, community-based groups in D.C.

AIDS advocates say that this makes sense, in some ways, because the city wanted to reach people that had historically been overlooked by more established providers.

The problem is that some of these groups had no background in HIV/healthcare/housing, and no one was tracking the money once it was delivered.

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"Heads should roll. Instead, bonuses all around.": From Wall Street to Main Street that seems to be the way things work these days.

Debbie Cenziper: Interesting.

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Arlington, Va.: Yes, please give us info about the bigger groups. I used to donate to Food & Friends, but a $300K salary for the CEO made me reroute my funds elsewhere.

Thank you for this important series.

Debbie Cenziper: We'll definitely continue to write about the more reputable groups as well.

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Debbie Cenziper: Thanks so much for writing in today. I enjoyed chatting with you. This is an ongoing investigation so please keep reading. We have more stories on the way.

I can be reached directly at 202-334-6107, so give me a call with tips or suggestions.

Take care.

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Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.


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