The audit examined 11 of the 60 contractors paid for HIV/AIDS work by the state Health Department and found problems only with the Philadelphia Health Department, which receives about half of the state’s HIV/AIDS prevention money.
The report found that in fiscal year 2008, the department accrued more than $700,000 in waste, abuse and possible fraudulent spending. Nan Feyler, chief of staff of the Philadelphia Health Department, said the department currently has a budget of $47 million.
Among the examples given of inappropriate use of funds was about $7,500 to take a group of college students who attended an HIV-awareness program to a waterpark in Wildwood, N.J.; about $2,200 for food at three HIV/AIDS discussions at a local university; and $13,000 for T-shirts for an HIV/AIDS event. There was also no documentation for more than $64,000.
Also cited was $2,100 given to participants in TEACH Outside, an HIV-education program run by Philadelphia FIGHT. At the completion of the five-week program, which is designed for HIV-positive individuals who’ve recently been incarcerated, the participants — who that year totaled 21 — received $100 checks for their participation.
“We do not agree that awarding cash to individuals who participate in a program is an appropriate use of commonwealth funding,” the audit stated.
Feyler, however, disagreed, noting that the Centers for Disease Control advocates for such monetary stipends to garner participation in HIV-education programs.
“I think that that is the kind of incentive that should be offered to vulnerable populations, as we try to help support their efforts to live healthy lives and understand transmission,” she said. “I have no problem with that at all.”
FIGHT executive director Jane Shull said the incentives are an important part of attracting their target population.
“Our experience with this is that people may come for the money but they stay for the program,” she said. “This being a program for ex-offenders, if we didn’t have something to offer them, it would be very difficult to recruit for this program and difficult for people who participate to actually be able to attend. And the use of stipends and incentives is extremely well-established in scientific literature and is something that is known to be effective across many public-health interventions, not just HIV.”
Shull noted that the audit mentions several times the idea that HIV-prevention messages can be effectively communicated over the Internet — to save money on such programs as TEACH Outside — which she said demonstrates the auditor general’s lack of knowledge about the digital divide in Philadelphia.
“African Americans, Hispanics and those making under $50,000 a year, which is the exact demographics of TEACH Outside, have Internet access at a rate of under 50 percent,” she said. “The population we’re trying to reach with this program does not have access to the Internet and cannot afford it in their homes and will not be reached if we don’t have face-to-face methods.”
Shull said FIGHT has invited Auditor General Jack Wagner to its next TEACH Outside graduation this summer, so he can see the benefits of the program.
While Feyler approved of the TEACH Outside incentives, she did note that the city’s AIDS Activities Coordinating Office, which distributes the funding to HIV/AIDS service organizations, needs to streamline its policy on incentives.
“What we need to have, and what AACO is now working on, is a standard so that we can all be on the same page on where we stand on incentives and so we can all be held accountable,” Feyler said.
Also included in the audit were 45 duplicate invoices, totaling $223,000, submitted to the state from the Philadelphia Health Department.
Feyler said the double-invoicing was not intentional.
“It was completely accidental and was really a result of a change in personnel at the time. There had been an abrupt departure of an important member of personnel and a delay in filling the position,” she said. “Our checks and balances were not operating well. We weren’t operating a tight ship, so to speak.”
Despite the duplicate invoices, however, Feyler noted that nearly 30 other invoices went unpaid by the state, which she said evened the funding.
“While there was some double-invoicing, we have reconciled with the state and received written assurance that there’s no reimbursement necessary. There was no fraud and no overpayment. We didn’t get a penny more than was allocated.”
Feyler said that even before the audit, the department had been working to rectify the process failures that led to the recent report.
“At the time, we were not requiring entities we contract with to provide information about their subcontractors and the expenditures made, and we’re now requiring source documentation, including back-up invoices and setting up a standard for incentives. What this was for us was a wake-up call, and we’re already in much better shape.”
Jen Colletta can be reached at email@example.com.