A Maryland state agency failed to adequately monitor groups to which it provided funding to treat opioid and gambling addictions and care for severely disabled children, according to a state audit released last week, raising questions about whether clients received proper treatment and how millions of taxpayer dollars were spent.

The Behavioral Health Administration could not prove that it reviewed reports submitted by groups it paid to provide treatment for substance abuse disorder, the audit said. The agency did not adjust funding even when the organizations reported they had not met performance measures cited in the grant agreements. One group received funding for 12,000 clients but served fewer than 8,000, the audit said.

The review, conducted between July 2014 and November 2017, also found that the Behavioral Health Administration failed to monitor a program for problem gamblers run by the University of Maryland School of Medicine, and did not carefully track which services were provided under a $2.9 million contract for children with severe special needs.

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Maryland Health Secretary Robert R. Neall did not disagree with any of the major findings in the audit. He said in a response that was included in the report that officials at the Behavioral Health Administration “will ensure that personnel can conduct effective oversight by introducing and training relevant staff, supervisors, and managers on policies and procedures.”

The agency, which is part of the state Health Department, was created in 2014. It awarded $96.3 million in mental health grants to local groups in fiscal 2017, along with $109.3 million for substance abuse disorder treatment. Opioids killed a record number of people in Maryland last year, and state spending to fight addiction is soaring, even as officials report signs that the epidemic may be slowing.

The center for problem gambling was billed as the first of its kind in the state when it opened in 2012. The Behavioral Health Administration did not ensure the center was properly administering its website, the audit found. The site was down for 10 days in May.

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When auditors were able to access the site, “it was populated with information promoting travel and casinos in Las Vegas, Nevada, rather than with information about problem gambling programs and resources,” the audit said.

A spokesperson for the U-Md. School of Medicine did not immediately return requests for comment Monday.

Neall, in his response, said the agency “will improve monitoring and oversight of contract deliverables by clearing up the reporting structure and role of Department employees in the oversight process.”

The audit found the agency paid a vendor $2.875 million for a nine-month period from 2015 until 2016 to serve special needs children but did not verify information including how many children were served, their names and the duration of services. Neall said staff will review invoices and “recover payments as appropriate.”

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In two instances, the audit found that the Health Department’s Office of Inspector General has referred instances of “questionable activity” to the criminal division of the office of Attorney General Brian E. Frosh (D).

The inspector general concluded that the Behavioral Health Administration may have violated procurement regulations by requiring a local group to hire as many as 13 individuals — some of them former agency employees — as consultants, at a cost of $2.6 million in fiscal 2018.

In addition, the inspector general identified concerns about the administration of funds through the Opioid Operational Command Center, which Gov. Larry Hogan (R) created by executive order in 2017.

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The center received $16.2 million from the health department in fiscal 2019, and $10.5 million the previous year, to administer grants for crisis response services, alternatives to incarceration and dismantling drug trafficking organizations.

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A referral to Frosh’s office “does not mean that a criminal act has actually occurred or that criminal charges will be filed,” the audit noted.

Frosh’s spokeswoman Raquel Coombs said the office could not confirm or deny the existence of investigations.

“As the auditor himself attests, our Health Department is working diligently to address these issues,” Hogan spokesman Mike Ricci said.