Why OIG Did This Review. Health centers are organizations that provide primary care to medically underserved populations. In FY 2018, Federal support for health centers totaled $5.4 billion. HRSA administers Federal grants that help health centers serve 1 in 12 people in the United States. These grants, called Service Area Competition grants, are typically awarded to health centers serving communities with limited access to affordable health care services. To maximize access to health care, HRSA sometimes funds health centers that are out of compliance with multiple program requirements or are not financially stable--i.e., health centers with elevated programmatic or financial risks. When funding grantees with unknown risks, effective oversight is needed to ensure that patients receive quality care and Federal grant funds are protected. Effective oversight is particularly important as Federal investment in the Health Center Program expands. Federal support for health centers has more than doubled from $2.2 billion in FY 2010 to $5.4 billion in FY 2018. How OIG Did This Review We analyzed HRSA data from 2013 through 2015 related to the 309 health centers that received Service Area Competition grants for FY 2014. We used HRSA's risk assessments to identify health centers with elevated risk. For these health centers, we reviewed nearly 2.5 years of HRSA actions to help the health centers improve. What OIG Found. Twenty-five percent of the health centers to which the Health Resources and Services Administration (HRSA) awarded Service Area Competition grants in FY 2014 had elevated programmatic or financial risks. Included among these health centers were two that did not meet HRSA's funding criteria. HRSA took steps to help health centers improve, and many were able to do so. However, HRSA missed some opportunities to further minimize risk. HRSA did not always limit project periods, restrict funding, or conduct site visits when it should have, exposing Federal funds to potential negative effects. In addition, HRSA was not always able to help health centers, particularly those with financial problems, to improve before awarding them additional years of funding. What OIG Recommends and How the Agency Responded. During this study, the Office of Inspector General (OIG) provided technical assistance to HRSA as it improved its oversight and worked to update its risk management process to implement new guidance from the Department of Health and Human Services. According to HRSA, it made changes in its risk management process based on this early information from OIG. This report provides two additional recommendations to help HRSA in its ongoing efforts to strengthen oversight of the Health Center Program. Specifically, we recommend that HRSA (1) use risk management interventions in accordance with its policies to help health centers reduce elevated risks and (2) explore additional steps it could take to help health centers reduce elevated risks. HRSA did not concur or nonconcur with our recommendations, but it noted actions it has taken that are responsive to them.
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