HARRISBURG, PA — Pennsylvania’s top fiscal watchdog sharply criticized the state Department of Health on Thursday after a fifth consecutive audit found sweeping failures in oversight of a multimillion-dollar fund meant to support emergency medical services across the Commonwealth.
Auditor General Tim DeFoor said the Department of Health still lacks adequate internal controls over the Emergency Medical Services Operating Fund (EMSOF), despite 15 years of audits warning that the agency cannot verify how much of the money distributed to EMS councils and the State EMS Advisory Board is actually being used for its intended purposes.
“In audit after audit, DOH said things would change,” DeFoor said. “After 15 years of audits, DOH doesn’t really know if the money it distributed to help EMS was used for allowable purposes 68 percent of the time. This is unacceptable.”
The latest audit reviewed the four-year period from July 1, 2021 through June 30, 2024, during which DOH distributed $37.9 million from the EMSOF. While auditors reported no issues with the portion of the fund dedicated to the Head Injury Program — roughly 25 percent of all dollars — they issued two findings and 18 recommendations for the remaining $29.3 million intended to sustain the state’s EMS network.
DeFoor said many of the recommendations echoed concerns first raised more than a decade ago.
“At a time when emergency medical services are losing critical, life-saving resources, not one dollar can be wasted,” he said. “Today we laid out 18 recommendations to improve DOH’s oversight of EMSOF, and most we have been making for 15 years.”
Auditors found DOH failed to properly monitor the program, even after hiring new management and replacing its invoicing system. The department also did not ensure that the 13 regional EMS councils and the State EMS Advisory Board met annual reporting and audit requirements designed to ensure transparency.
The report concluded that DOH has not adequately implemented most of the corrective recommendations issued in the 2023 audit, calling the previous findings unresolved.
Among the new recommendations, auditors urged the department to tighten internal controls by requiring councils and the advisory board to comply with all policies before payments are issued — and to withhold funds when documentation is missing or incomplete.
EMSOF draws its revenue from fees associated with moving traffic violations and the state’s Accelerated Rehabilitative Disposition program. The fund supports training and certification programs, quality-assurance oversight, data reporting, and licensure of ambulance and medical response services.
The full audit and previous EMSOF reviews are available at www.paauditor.gov.
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