The Indian Health Service Did Not Always Resolve Audit Recommendations in Accordance With Federal Requirements

The U.S. Department of Health and Human Services (HHS), Indian Health Service (IHS), did not always resolve audit recommendations in a timely manner during Federal fiscal years (FYs) 2015 and 2016. Specifically, IHS resolved 138 of the 651'recommendations that were outstanding during FYs 2015 and 2016.' However, it did not resolve 123 of the 138 recommendations (89.1 percent) within the required 6-month resolution period.' In addition, as of September 30, 2016, IHS had not resolved 513 audit recommendations that were past due for resolution. These 513 past-due recommendations were procedural in nature and typically involved policies and procedures and internal controls; none of them involved dollar amounts such as recommended disallowances.

IHS had policies and procedures in place to ensure that non-Federal audit recommendations were resolved in compliance with Federal requirements, and these policies and procedures specifically stated that audit recommendations are considered unresolved if they are not resolved within 6 months of the audit report's issue date. However, IHS did not generally follow these policies and procedures. As a result, for non-Federal audits, IHS did not usually issue management decisions and submit the related clearance documents within the required 6-month resolution period. According to IHS officials, IHS did not always take these steps primarily because audit resolution was not always given high priority by the contracting officers responsible for obtaining management decisions and issuing appropriate documentation, due to competing responsibilities and limited resources.

Without resolving all audit recommendations in a timely manner, IHS runs the risk of noncompliance with Federal requirements and mismanagement of Federal funds. The prompt resolution of audit recommendations helps ensure that Federal funds are effectively and efficiently used to carry out the activities for which they were authorized.

We recommended that IHS follow, and where necessary update, its policies and procedures related to the non-Federal and Federal audit resolution processes; promptly resolve the 513 outstanding audit recommendations that were past due as of September 30, 2016; follow the reconciliation process that it implemented at the end of our audit period; and give higher priority to audit resolution in accordance with Federal requirements.

IHS concurred with all of our recommendations and described corrective actions that it had taken or planned to take. IHS said that it planned to have Federal audit resolution policies and procedures in place by November 30, 2018. IHS also stated that it would identify and promptly resolve any recommendations that were past due as of September 30, 2016, and that it would continue to perform quarterly reconciliations to identify open audits and to oversee performance by responsible officials.