The District's HIV/AIDS Administration is not properly monitoring the organizations that deliver services to residents infected with the deadly virus, at times preparing "questionable reports" or funding groups not necessarily involved with AIDS, according to a critical audit released yesterday.
The audit by the D.C. inspector general follows a month of criticism of the agency, part of the city's Health Department, for reimbursing service providers so late that some were in danger of closing.
It found that HAA issued $8 million in grants to 19 providers that were not authorized to do business in the District because their incorporation papers had been revoked or because they did not have the required business licenses.
"HAA's lack of stringent controls over selecting and monitoring businesses to provide needed services to the District residents put the District at risk for awarding grants to unlicensed subgrantees who provide serious health care services," Inspector General Austin A. Andersen said in the audit.
The audit also found that HAA's grant monitors did not adequately oversee the providers' performance. Although the monitors are required to visit providers at least four times a year and are required to prepare reports on their findings, the auditors found that this rarely occurred. One grant monitor had not done a single site visit in nearly a year; another submitted four reports with identical wording.
In following up on the monitors, the inspector general's office could not reach 13 of 55 providers by phone and determined that six providers were not at the addresses listed on their grant agreements. Two locations seemed to provide no HIV-AIDS services at all, according to the audit.
The audit also found that the administration's own fiscal accountability was inadequate and that employees could not provide budget and expenditure details on individual grants. The administration received more than $137 million in federal HIV-AIDS grants in fiscal 2002 and 2003, the years at issue in the audit.
Health Director Gregg A. Pane, reached by telephone yesterday, said he "basically agreed with their findings," although he pointed out that most involved activity from several years ago. "There are still lessons to be learned," he said. "I think some of these are still issues today."
The department has responded with specific written recommendations.
Pane also noted the praise that the administration received during a D.C. Council hearing yesterday for quick turnaround on recent payments to providers. One nonprofit director called it "a miracle."
But the audit found that in the years reviewed, there was poor oversight to ensure who was actually delivering the services funded by the city. "Although there were many instances where service deliverables were met and often exceeded, we found instances where subgrantees did not meet their targets for providing services," the inspector general said.
Providers who receive more than $300,000 a year are required under federal regulations to get independent audits. A survey of 23 providers found that three of them, including one provider that had received $9 million in grants, had not submitted audits for the two years and still received additional grants.