Review of Ryan White Title II Funds at the Puerto Rico Health Department

EXECUTIVE SUMMARY:

Our objectives were to determine, for the period April 1, 2001, through March 31, 2002, whether the Puerto Rico Health Department: (1) claimed CARE Act Title II expenditures in accordance with Federal requirements, and (2) purchased prescription drugs at the lowest price available.  We found that the Health Department claimed $1,567,993 for costs that were not allowable.  The Health Department also did not establish procedures to ensure that the CARE act Title II program was the payer or last resort.  The Health Department did not always purchase drugs at the lowest price available or take advantage of all prompt payment discounts. 

We recommended that the Health Department:  (1) refund to HRSA $1,567,993 for unallowable costs; (2) ensure that expenses claimed include only actual paid amounts; (3) ensure that amended Financial Status Reports are submitted when overcharges are discovered; (4) ensure that Title II is the payer of last resort for clients who have drug insurance coverage or are enrolled in other assistance programs; (5) refund to HRSA $1,117,831 for medications that were not purchased at the lowest price; and, (6) establish procedures to ensure that invoices are paid within the discount periods.  In its reply to the draft report, the Health Department neither concurred nor nonconcurred with our recommendations, but did express its intention to continue working on the issues raised.