Audit Reveals Ongoing Problems at Pennsylvania Department of Health

Auditor General Tim DeFoorCredit: Commonwealth Media Services

PENNSYLVANIA — The Pennsylvania Department of Health’s (DOH) distribution of funds from the Emergency Medical Services Operating Fund (EMSOF) to regional EMS councils and the State EMS Advisory Board has been flagged for a lack of internal controls, according to Auditor General Tim DeFoor’s most recent performance audit.

“Our performance audit had one objective: ensure the Department of Health properly accounted for the EMSOF,” DeFoor said. “This is the fourth performance audit of DOH’s administration of EMSOF since 2010 and the fourth time we found significant internal control issues that remain uncorrected. The good news is that DOH agrees with our findings and is using our audit as a roadmap to improve its infrastructure and oversight.”

The audit period ranged from July 1st, 2017 to June 30th, 2021. The results showed no issues with DOH’s Head Injury Program – a quarter of the total fund. However, the remaining $34.8 million, dedicated to supporting the statewide EMS system, had three findings and nine recommendations for DOH’s administration.

The findings included:

  • DOH continued to ineffectively administer the EMSOF and failed to correct past significant weakness in its internal controls;
  • DOH failed to adequately monitor and question potential misuse of EMS operating fund expenditures; and
  • DOH failed to adequately review annual reports for completeness and accuracy.

Auditors recommended improving internal controls to ensure complete and accurate public disclosure. Specifically, this includes developing policies and procedures for processing and reviewing relevant documentation, and conducting training and staffing assessments as necessary. Additionally, they advised training regional EMS councils on EMSOF spending guidelines. DOH should address deficiencies in annual reports to prevent inaccurate information from being released.

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The financially self-sufficient Emergency Medical Services Operating Fund (EMOF) is sustained through fees generated from moving traffic violations and the Accelerated Rehabilitative Disposition program. Seventy-five percent of EMOF’s provisions are allocated to State EMS Advisory Board and 13 regional EMS councils, empowering training and certification of personnel, patient quality assurance, data collation and documentation. Additionally, EMOF finances the licensing of all ambulances and various medical response services.

To read the full audit, including past EMSOF audits, visit the Auditor General’s website at

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