GAO Finds HRSA Failing Taxpayers, Patients, Due to Ineffective Management of Community Health Center Program

Press Release

Today, U.S. Senators Tom Coburn, M.D. (R-OK), Michael Enzi (R-WY), and Richard Burr (R-NC) sent the following letter to Health Resources and Services Administration (HRSA) Administrator Mary Wakefield, PhD, RN, coinciding with two new reports, requested by the Senators, that the Government Accountability Office (GAO) released today. These reports highlight management deficiencies by HRSA in overseeing the Health Center Program. GAO's first report underscores the need for improved oversight by HRSA to ensure grantees comply with the Administration's requirements. In the second report, GAO examines the health center's collaboration and competition with other health providers in the community.

In their letter, the Senators ask HRSA for a management plan to address deficiencies and other concerns outlined in both GAO reports.

"Though millions of underserved and low-income Americans are helped by the medical care and services they receive at health centers, the benefits of the program are more attributable to local health care providers than to HRSA's administration. As the GAO reports detail, HRSA's management of the program is inconsistent, inadequate, and inexcusable. Given the lack of strong internal controls and transparency, we are concerned that HRSA's mismanagement of the program could potentially waste taxpayer dollars or jeopardize patients' access to care," Coburn, Enzi and Burr wrote to Wakefield.

Background on the Community Health Center program:

HHS' Health Resources and Services Administration (HRSA) provides grants to eligible health centers under Section 330 of the Public Health Service Act. In 2010, grants helped fund more than 1,100 health center grantees that provided services at more than 8,100 health care delivery sites and served nearly 19.5 million people. These grants made up over 20 percent of all health center grantees' revenues in 2010. Health centers funded through HRSA's Health Center Program are typically managed by an executive director, a financial officer, and a clinical director, and provide comprehensive primary care services including enabling services, such as translation and transportation, that help facilitate access to health care.

Key findings highlighted in GAO's first report, "Health Center Program: Improved Oversight Needed to Ensure Grantee Compliance with Requirements"

To oversee grantees, HRSA relies on three tools: annual compliance reviews, site visits, and routine communications.
HRSA's timeframe for addressing grantee noncompliance can be overly generous.
HRSA's process for identifying noncompliance is insufficient.
HRSA's use of site visits to assess compliance is unclear.
HRSA's project officers do not consistently identify and document grantee noncompliance.

Key findings highlighted in GAO's second report, "Health Center Program: 2011 Grant Award Process Highlighted Need and Special Populations and Merits Evaluation"

HRSA intends to encourage collaboration in grant-making.
Health centers and providers in the communities GAO studied generally do not compete for patients.
Competition is more likely in rural areas, noting greater potential for competition between health centers and hospitals under "certain circumstances".

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