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Nationwide Audit of State and Local Government Efforts to Record and Monitor Subrecipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"The objectives of this audit were to determine whether awardees: recorded, summarized, and reported bioterrorism program transactions by focus area in accordance with their cooperative agreements; established procedures to monitor subrecipient expenditures; and had unobligated fund balances as of August 30, 2003. We determined that of the 17 audited awardees: fourteen recorded, summarized, and reported bioterrorism program funds by focus area; six had developed adequate procedures to monitor subrecipient expenditures; and fifteen had unobligated balances of Federal bioterrorism funds as of August 30, 2003 totaling approximately $65 million, or 15 percent of the $428 million awarded. We recommended that CDC: (1) continue to emphasize the requirement to account for funds by focus area; (2) identify awardees that have not accounted for their funds in accordance with the cooperative agreements and ensure that they revise their accounting procedures; (3) provide guidance to awardees on monitoring subrecipient expenditures and measuring subrecipient performance, including emphasizing the need for awardees to make site visits to directly review subrecipients' expenditures and assess subrecipients' progress in improving bioterrorism preparedness; and (4) identify the reasons for large unobligated balances and assist the awardees in overcoming barriers to a more timely use of funds. In response, the CDC officials agreed with the findings and recommendations."
United States. Department of Health and Human Services. Office of Inspector General
2004-08-05
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Summary Report on Select Agent Security at Universities
"The final report consolidates results from our reviews of select agent security at 11 universities. In general, serious weaknesses that compromised the security of select agents existed at all 11 universities. Physical security weaknesses left select agents vulnerable to theft or loss, thus elevating the risk of public exposure. Inadequate inventory and recordkeeping procedures prevented us from concluding that the universities had complied with the select agent transfer requirements. At least half the universities had inadequate procedures for identifying persons barred from accessing select agents. Five universities that used information technology resources for select agent data exhibited control weaknesses that could compromise the security and integrity of the data. The OIG reports contained numerous recommendations for strengthening physical security, compliance with the select agent transfer requirements, controls over restricted person access, and information technology controls. In general, the universities agreed with the OIG recommendation and began implementing corrective actions."
United States. Department of Health and Human Services. Office of Inspector General
2004-03-25
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District of Columbia's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"Our audit objectives were to determine whether the District of Columbia Department of Health (District) properly recorded, summarized and reported bioterrorism preparedness transactions by specific focus area designated in the cooperative agreements and whether the District has established controls and procedures to monitor sub-recipients' expenditures of Centers for Disease Control and Prevention (CDC) funds. We found that the District generally accounted for Program funds in accordance with the terms and conditions of the cooperative agreement and applicable departmental regulations and guidelines. Specifically, the District recorded, summarized and reported bioterrorism transactions by specific focus area. However, in Fiscal Year 2002, the supplemental funds were not segregated by focus area. The District did not have a system to track and monitor sub-recipients; such as, application and award processes, grant conditions, ongoing fiscal activities, and reporting."
United States. Department of Health and Human Services. Office of Inspector General
2004-01-30
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City of Chicago's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"The objectives of this review were to determine whether the Chicago Department of Public Health (Department): (i) properly recorded, summarized and reported bioterrorism preparedness transactions by specific focus areas designated in the cooperative agreements and (ii) whether the Department had controls and procedures to monitor sub-recipient expenditures of Centers for Disease Control and Prevention (CDC) funds. We found that the Department generally accounted for program funds in accordance with the terms and conditions of the cooperative agreement and applicable departmental regulations and guidelines, with two exceptions. During Year 1 of the Program, the Department did not record, summarize and report transactions by specific focus area. We verified that the Department took corrective action and segregated expenditures by focus area during the succeeding Program years. In addition, Year 3 original and supplemental funds were not segregated in the accounting system. Although the cooperative agreement does not require separate accounting for original and supplemental funds, separate reporting of the funds is required. We recommended the Department implement procedures to record, summarize, and report expenditures for original and supplemental grant funds separately. Department officials generally concurred with our findings and recommendation."
United States. Department of Health and Human Services. Office of Inspector General
2003-11-20
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State of Georgia's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"This final report points out that the Georgia Department of Human Resources (Georgia) generally accounted for program funds ($27.1 million received as of April 30, 2003 for the 4-year period ending August 30, 2003) in accordance with the terms and conditions of the cooperative agreement with the Centers for Disease Control and Prevention (CDC) and applicable departmental regulations and guidelines. Specifically, Georgia recorded, summarized and reported transactions by specific focus area. When Georgia contracts with sub-recipients, it has monitoring procedures in place. In addition, Georgia is developing a site visit component. Further, Georgia officials indicated that CDC funding had not been used to supplant programs previously funded by other organizational sources. We recommended Georgia implement sub-recipient monitoring when contracts are awarded, and address problem areas, as they are identified. Georgia concurred with our findings and recommendation and is taking corrective actions to improve its bioterrorism grant program."
United States. Department of Health and Human Services. Office of Inspector General
2003-11-12
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State of Illinois' Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"Our objectives were to determine whether the Illinois Department of Public Health (State agency): (i) properly recorded, summarized and reported bioterrorism preparedness transactions by specific focus areas designated in the cooperative agreements and (ii) whether the State agency had controls and procedures to monitor sub-recipient expenditures of Centers for Disease Control and Prevention funds. We found that the State agency generally accounted for program funds by specific focus area. In response to our inquiry as to whether the State agency reduced funding to existing public health programs, State officials replied that Program funding had not been used to supplant existing State or local programs. We recommended the State agency continue to comply with the terms and conditions of the cooperative agreements. The State agency concurred with our findings and recommendation."
United States. Department of Health and Human Services. Office of Inspector General
2003-10-31
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Review of New York City's Efforts to Account for and Monitor Sub-Recipients' Use of Bioterrorism Hopstial Preparedness Program Funds
"This final report presents the results of the Office of Inspector General's self-initiated audit entitled, 'Review of New York City's Efforts to Account for and Monitor Sub-recipients' Use of Bio-terrorism Hospital Preparedness Program Funds.' The objectives were to determine whether Health Research, Incorporated (HRI) properly recorded, summarized and reported bio-terrorism preparedness transactions in accordance with the terms and conditions of the cooperative agreement with the Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA). In addition, we inquired as to whether the Bio-terrorism Hospital Preparedness Program (the Program) funding supplanted programs previously funded by other organizational sources and whether HRI and the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) established controls and procedures to monitor sub-recipients' expenditures of HRSA funds. Our review found that HRI accounted for the Program funds in accordance with the terms and conditions of the cooperative agreement with HRSA. Specifically, HRI recorded, summarized and reported transactions in discrete accounts established to account for bio-terrorism funding. In response to our inquiry as to whether DOHMH reduced funding to existing public health programs, DOHMH officials stated that HRSA funding had not been used to supplant existing State or local programs. We also found that, while HRI and DOHMH implemented controls and procedures to monitor sub-recipient's expenditures of HRSA funds, they are not currently performing on-site audits of sub-recipients. However, HRI and DOHMH indicated that they plan to add an on-site audit component to their monitoring procedures with funding from the Program."
United States. Department of Health and Human Services. Office of Inspector General
2003-11
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State of Florida's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"This final report points out that the Florida Department of Health (Florida) generally accounted for program funds ($44.8 million received for the 4-year period ending August 30, 2003) in accordance with the terms and conditions of the cooperative agreement with the Centers for Disease Control and Prevention (CDC) and applicable departmental regulations and guidelines. Specifically, Florida recorded, summarized and reported transactions by specific focus area. At the time of our review, Florida did not have any sub-recipients. When Florida contracts with sub-recipients, it has monitoring procedures in place. In addition, Florida is developing a site visit component. Further, Florida officials indicated that CDC funding had not been used to supplant programs previously funded by other organizational sources. We recommended Florida implement sub-recipient monitoring when contracts are awarded, and address problem areas, as they are identified. Florida concurred with our findings and recommendation and is taking corrective actions to improve its bioterrorism grant program."
United States. Department of Health and Human Services. Office of Inspector General
2003-10-21
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Review of the State of North Carolina's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds: North Carolina Division of Public Health
"This final report points out that the North Carolina Division of Public Health (North Carolina) generally accounted for program funds ($25.1 million received for the 4-year period ending August 30, 2003) in accordance with the terms and conditions of the cooperative agreement with the Centers for Disease Control and Prevention (CDC) and applicable departmental regulations and guidelines. Specifically, North Carolina recorded, summarized and reported transactions by specific focus area. In addition, North Carolina's monitoring procedures for contracts and its advanced accounting system facilitated the tracking and monitoring of subrecipient activities and expenditures. Further, North Carolina officials indicated that CDC funding had not been used to supplant programs previously funded by other organizational sources. We recommended North Carolina: (1) develop written policies and procedures for tracking the Program fund activities within the financial accounting system; and (2) implement plans to increase the coordination of monitoring activities for subrecipients of the Program. North Carolina concurred with our findings and recommendations and is taking corrective actions to improve its bioterrorism grant program."
United States. Department of Health and Human Services. Office of Inspector General
2003-10-17
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Commonwealth of Virginia's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"The objectives of this audit were to determine whether the Virginia Department of Health (State agency) properly recorded, summarized and reported bioterrorism preparedness transactions by specific focus area designated in the cooperative agreements and whether the State agency has established controls and procedures to monitor sub-recipient expenditures of Centers for Disease Control and Prevention funds. We found that the State agency generally accounted for Program funds in accordance with the terms and conditions of the cooperative agreement and applicable departmental regulations and guidelines. The State agency had a system to track and monitor sub-recipient activities; such as, application and award processes, grant conditions, ongoing fiscal activities, and reporting. At the time of our review, the State agency had only one sub-recipient, the Division of Consolidated Laboratory Services (Consolidated), a division of the Department of General Services, another Virginia State agency. In its memorandum of agreement with Consolidated, the State agency required no written reports."
United States. Department of Health and Human Services. Office of Inspector General
2003-10-17
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State of Maryland's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"The objectives of this audit were to determine whether the Maryland Department of Health and Mental Hygiene (State agency) properly recorded, summarized and reported bioterrorism preparedness transactions by specific focus area designated in the cooperative agreements and whether the State agency has established controls and procedures to monitor sub-recipients' expenditures of Centers for Disease Control and Prevention funds. We found that the State agency generally accounted for Program funds in accordance with the terms and conditions of the cooperative agreements and applicable departmental regulations and guidelines. Specifically, the State agency recorded, summarized and reported transactions by specific focus area. The State agency had a system to track and monitor sub-recipient activities; such as, application and award processes, grant conditions, ongoing fiscal activities, and reporting. In addition, the State agency was planning to add reviews of Program funds to current audits performed on sub-recipients."
United States. Department of Health and Human Services. Office of Inspector General
2003-10-16
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Review of New York State's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bio-terrorism Program Funds
"The objectives of this review were to determine whether Health Research, Incorporated (HRI) properly recorded, summarized and reported bio-terrorism preparedness transactions by specific focus areas designated in the cooperative agreements. We found that HRI accounted for bio-terrorism program funds in accordance with the terms and conditions of the cooperative agreements with the Centers for Disease Control and Prevention (CDC). HRI officials stated that CDC funding had not been used to supplant existing State and local programs. We also found that, while HRI implemented procedures to monitor sub-recipient's expenditures of CDC funds, they are not currently performing on-site audits of sub-recipients. However, HRI officials indicated that they plan to implement an on-site audit component to their monitoring procedures in the future. We recommended that HRI continue to implement plans to add an on-site audit component for monitoring sub-recipients and address problem areas, as they are identified. State officials concurred with our recommendation."
United States. Department of Health and Human Services. Office of Inspector General
2003-10-15
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Review of New York City's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response of Bio-Terrorism Program Funds
"This final report presents the results of the Office of Inspector General's self-initiated audit entitled, "Review of New York City's Efforts to Account for and Monitor Sub-recipients' Use of Public Health Preparedness and Response to Bio-Terrorism Program Funds." The objectives were to determine whether the New York City Department of Health and Mental Hygiene (DOHMH) and the Medical and Health Research Association of New York City (MHRA) properly recorded, summarized and reported bio-terrorism preparedness transactions by specific focus areas designated in the cooperative agreements. In addition, we inquired as to whether bio-terrorism funding supplanted programs previously funded by other organizational sources and whether DOHMH and MHRA established controls and procedures to monitor sub-recipients' expenditures of Centers for Disease Control and Prevention (CDC) funds. Our review found that DOHMH and MHRA accounted for bio-terrorism program funds in accordance with the terms and conditions of the cooperative agreements with CDC. Specifically, DOHMH and MHRA recorded, summarized and reported transactions in discrete accounts established to account for bio-terrorism funding. In response to our inquiry as to whether
DOHMH reduced funding to existing public health programs, DOHMH officials stated that CDC funding had not been used to supplant existing State or local programs. In addition, based on the results of the questionnaires and interviews with MHRA officials, we found the MHRA had adequate controls and procedures to monitor sub-recipient expenditures of CDC funds."
United States. Department of Health and Human Services. Office of Inspector General
2003-10-15
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Review of New Jersey's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bio-terrorism Program Funds
"The objectives of this review were to determine whether the State of New Jersey Department of Health and Senior Services (DHSS) properly recorded, summarized and reported bio-terrorism preparedness transactions by specific focus areas designated in the cooperative agreements. In addition, we inquired as to whether bio-terrorism funding supplanted programs previously funded by other organizational sources and whether DHSS established controls and procedures to monitor sub-recipient's expenditures of Centers for Disease Control and Prevention (CDC) funds. Our review found that DHSS accounted for bio-terrorism program funds in accordance with the terms and conditions of the cooperative agreements with CDC. DHSS officials stated that CDC funding had not been used to supplant existing State and local programs. DHSS did not perform site visits to its sub-recipients. We recommended that DHSS consider implementing a site visit component to its procedures for monitoring sub-recipients and address problem areas, as they are identified. New Jersey Officials concurred with our recommendation."
United States. Department of Health and Human Services. Office of Inspector General
2003-10-15
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State of Michigan's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"Our objectives were to determine whether the Michigan Department of Community Health (State agency): (i) properly recorded, summarized and reported bioterrorism preparedness transactions by specific focus areas designated in the cooperative agreements and (ii) whether the State agency had controls and procedures to monitor sub-recipient expenditures of Centers for Disease Control and Prevention (CDC) funds. We found that the State agency generally accounted for program funds by specific focus area. In response to our inquiry as to whether the State agency reduced funding to existing public health programs, State officials replied that Program funding had not been used to supplant existing State or local programs. We recommended the State agency continue to comply with the terms and conditions of the cooperative agreements. The State agency concurred with our findings and recommendation."
United States. Department of Health and Human Services. Office of Inspector General
2003-10-07
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State of Massachusett's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"The objective of this review was to determine whether the State: (1) properly recorded, summarized and reported bioterrorism preparedness transactions by specific focus area designated in the cooperative agreements; and (2) established controls and procedures to monitor subrecipients expenditures of Centers for Disease Control and Prevention (CDC) funds. We found that the State generally accounted for the Program funds in accordance with the terms and conditions of the cooperative agreement and applicable departmental regulations and guidelines. We recommended that the State implement the random audit component and address problem areas as they are identified to ensure adequate oversight of subrecipients. The auditee concurred."
United States. Department of Health and Human Services. Office of Inspector General
2003-10-06
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Los Angeles County's Efforts to Account for the Use of Public Health Preparedness and Response to Bioterrorism Program Funds and Monitoring of Subrecipients
"The objectives of this review were to determine whether the Los Angeles County Department of Health Services (LA County): (i) properly recorded, summarized and reported bioterrorism preparedness transactions by specific focus area designated in the cooperative agreements, (ii) established controls and procedures to monitor subrecipients' expenditures of Centers for Disease Control and Prevention (CDC) funds; and (iii) used bioterrorism program (Program) funds to supplant funds previously provided by other sources. We found that: (i) LA County did not properly report Program expenditures to CDC for the two reporting periods ended August 30, 2000 and 2001, (ii) had not conducted on site monitoring reviews because the subrecipients were generally in the planning stage; and (iii) had not used Program funding to supplant existing State or local funds. We recommended that LA County: (i) submit final Financial Status Reports that include actual expenditures with no outstanding obligations for reporting periods ended August 30, 2000 and 2001 and ensure that, in the future, final Financial Status Reports are submitted for reporting periods required by CDC; and (ii) implement the subrecipient monitoring procedures as planned. LA County officials concurred with our recommendations."
United States. Department of Health and Human Services. Office of Inspector General
2003-10-01
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State of Ohio's Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"Our objectives were to determine whether the Ohio Department of Health (State agency): (i) properly recorded, summarized and reported bioterrorism preparedness transactions by specific focus area designated in the cooperative agreements and (ii) whether the State agency had controls and procedures to monitor sub-recipient expenditures of CDC funds. Based on our validation of a questionnaire completed by the State agency and our site visit, we found that the State agency generally accounted for program funds by specific focus area. In response to our inquiry as to whether the State agency reduced funding to existing public health programs, State officials replied that program funding had not been used to supplant existing State or local programs. We recommended that the State agency implement the site visit component and address problem areas, as they are identified. The State agency concurred with our findings and recommendation."
United States. Department of Health and Human Services. Office of Inspector General
2003-09-19
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State of California: Review of Public Health Preparedness and Response for Bioterrorism Program Funds
"This final report points out that the California Department of Health Services (DHS) did not account for bioterrorism program funds ($4.9 million received for the 2-year period ending August 30, 2001) by focus area as required by the cooperative agreement with the Centers for Disease Control and Prevention (CDC), nor could it adequately support program expenditures on financial reports submitted to CDC. Specifically, DHS; 1) did not organize its accounting system to record, summarize, and report expenditures by program focus area, 2) relied on summary spreadsheets maintained outside the accounting system to prepare financial reports, 3) did not have adequate controls over the preparation and review of financial reports, and 4) did not adequately monitor sub-recipients. In addition to recommendations to correct accounting and procedural weaknesses, we recommended that DHS determine, in coordination with the CDC, the amount of bioterrorism program funds that were expended in each focus area, identify unallowable costs, and make adjustments to current and future awards so that funds are rebalanced by focus area to provide appropriate levels of preparedness. The DHS concurred with our findings and recommendations."
United States. Department of Health and Human Services. Office of Inspector General
2003-08-13
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State of Texas' Efforts to Account for and Monitor Sub-Recipients' Use of Public Health Preparedness and Response for Bioterrorism Program Funds
"The objective of this review was to determine whether: (1) the Texas Department of Health properly recorded, summarized and reported Public Health Preparedness and Response for Bioterrorism Program costs by specific focus area designated in cooperative agreements; (2) program funding supplanted programs previously provided by other organizational sources; and (3) the Department of Health had established controls and procedures to monitor subrecipients' expenditures of program funds. We noted one problem. At the start of 2003, Department of Health officials identified a problem with the payroll allocation that, if not corrected, could affect the accuracy of the year 3 financial status report due November 30, 2003. Officials at the Department of Health stated they should have the problem corrected in the next 2 or 3 months."
United States. Department of Health and Human Services. Office of Inspector General
2003-08-06
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State and Local Bioterrorism Preparedness
This Department of Health and Human Services (HHS) Office of Inspector General (OIG) report assesses "State and local health departments' capacity to detect and respond to a bioterrorism event. [...] The findings in this report show that our public health infrastructure has left us under-prepared to detect and respond to bioterrorism. Not all State and local health departments have sufficient staff, surveillance systems, technology, or laboratory capacity to quickly and accurately identify an attack. Some also lack the plans, partnerships, or authorities to adequately respond. Since the anthrax attacks in the Fall of 2001, health departments have started to reassess their preparedness and the Federal government has substantially increased funding to rebuild public health infrastructures. Based on these findings, we conclude that further work is needed at the Federal, State, and local levels to ensure that our countrys public health system is fully prepared to respond to bioterrorism."
United States. Department of Health and Human Services. Office of Inspector General
2002-12
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Emergency Medical Treatment and Labor Act: The Enforcement Process
"The purpose of this inspection was to evaluate the enforcement process for the Emergency
Medical Treatment and Labor Act (EMTALA). [...] Congress created a bifurcated enforcement mechanism for EMTALA within the
Department of Health and Human Services. The Health Care Financing Administration
(HCFA) authorizes investigations of dumping complaints by State survey agencies,
determines if a violation occurred, and, if appropriate, terminates a hospital's provider
agreement. The Office of Inspector General (OIG) assesses civil monetary penalties
against hospitals and physicians and may exclude physicians from the Medicare program
for repeated or gross and flagrant behavior. The HCFA 'may' seek the input of the local
peer review organization (PRO) after the State's investigation to help determine whether
the hospital adequately screened, examined, and treated a patient but 'must' seek PRO input
in most circumstances before forwarding a case to the OIG if the alleged violation involves
a question of medical judgment."
United States. Department of Health and Human Services. Office of Inspector General
2001-01
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Balance Billing for Medical Equipment and Supplies
This paper is meant to determine the effects and level of Medicare beneficiary awareness of balance billing for durable medical equipment and supplies. Part B of the Medicare program covers outpatient services and items, including durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Under Medicare Part B, physicians and suppliers submit both assigned and non-assigned claims for these services and items. For assigned claims, physicians and suppliers agree to accept the amount allowed by Medicare as full payment. Medicare pays 80 percent of this amount directly to the physician or supplier and the beneficiary pays 20 percent (plus any outstanding deductible). In non-assigned claims, the physician or supplier bills the beneficiary for the total charge for the service or item provided, which can exceed the amount allowed by Medicare. Medicare pays the beneficiary 80 percent of the allowed amount; the beneficiary pays all remaining charges. This paper defines balance billing as the portion of the charge in excess of the Medicare allowed amount.
United States. Department of Health and Human Services. Office of Inspector General
2001-01
