Officials with the federal Department of Health and Human Services will dispense an estimated $2.3 billion in grants to thousands of AIDS victims across the country under the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act).
And a new audit by the Government Accountability Office (GAO) of HHS’s Health Resources and Services Administration (HRSA), which is responsible for managing those billions of tax dollars, indicates government officials are more concerned about how things are going in places like sunny Puerto Rico than they are in troubled Detroit.
The list of management problems found in the White AIDS grants initiative are so serious, according to GAO, that they “may compromise its ability to ensure that this program is meeting its objectives or that CARE Act funds are being spent properly.”
Among the most significant deficiencies highlighted by the GAO were these:
* HRSA doesn’t “consistently follow guidance for documenting routine monitoring, prioritizing grantee site visits, reviewing annual single audit findings, or clearly communicating with grantees about the restrictive draw-down process.” The latter is an administrative enforcement process designed to prevent mismanagement of federal funds by grantees.
“We found that most of the PO files that we reviewed did not contain documentation of routine monitoring calls—of the 25 PO files for grantees in our sample, only 4 PO files contained documentation of monitoring calls at least quarterly in the 2010 grant files we reviewed, and only 8 contained documentation of quarterly calls in the 2011 grant files,” the GAO report said.
* HSRA doesn’t systematically conduct site visits to grantees required by federal law and doesn’t schedule the visits it does conduct according to such priorities as the time since a grantee’s last visit or the severity of problems previously documented for a grantee.
“We found that 44 percent of all Part A and Part B grantees did not receive a site visit from 2008 through 2011. In addition, 6 of the 25 grantees we interviewed told us that there had been a significant amount of time between HRSA site visits they had received or since their most recent site visit, ranging from 5 to 12 years,” the GAO report said.
Worse yet, GAO’s auditors found a pattern in which HSRA site visits were more frequently made to grantees at locations like Puerto Rico and the Virgin Islands than to grantees in locations like Pennsylvania and Michigan.
For example, San Juan, Puerto Rico, received $15 million in White grants in 2011 and was visited by HSRA officials nine times during the four years, compared to only three visits to Detroit where $8.9 million in grants generated only three visits.
And the report singled out California for special attention, noting that the Golden State “received the second largest 2011 grant award, approximately $150 million, based on an estimated 117,869 living HIV/AIDS cases at the end of 2009, but HRSA did not conduct any site visits there over the 4 years.”
The 82-page GAO study can be found here.