Public Health and Human Service Grants and Contracts

Key Terms

Through the awarding of grants and contracts, the Department of Health and Human Services (HHS) funds health care and human services throughout the United States.  Each year, HHS awards billions of dollars to grant recipients and contractors to deliver various public health and human services (PHHS) programs.  Award recipients include States, territories, Tribes, community organizations, educational institutions, and for-profit businesses.

For example, grants are used to support:

• medical research funded by the National Institutes of Health.
• care provided to children in Head Start programs and foster care.
• health centers that receive the Health Resources and Services Administration's funding to provide affordable, accessible, and high-quality primary health care to underserved communities.

Contracts are essential to:

• how the Indian Health Service funds health care provided by Tribes to American Indian and Alaska Native communities.
• the purchase of the Centers for Disease Control and Prevention's public health supplies.
• the delivery of high quality, secure, and efficient information technology solutions that enable the Food and Drug Administration to promote and protect public health.

Grant and contract dollars must be used for their intended purpose, and recipients must account for costs and justify expenditures.  The HHS Office of Inspector General (OIG) provides oversight to detect and deter misuse of these funds.  Our agency prioritizes work on grant and contract oversight.

Strategic Plan

Grants and contracts progress through a life cycle that includes four major stages: pre-award, award, post-award, and closeout.

OIG has identified unique risks and vulnerabilities within each stage, so robust oversight during the life cycle is necessary to support awardees' compliance with award requirements; achievement of program outcomes; and prevention of fraud, waste, abuse, and mismanagement.  Safeguarding the integrity of grants and contracts remains a significant challenge for HHS and is a priority area for OIG oversight.  To address risks associated with these funding sources, OIG developed a strategic plan to oversee a broad and diverse portfolio of more than 100 PHHS programs supported by grants and contracts.  The strategic plan includes three goals:

1. Strengthen compliance with requirements throughout the grants and contracts life cycle.
2. Promote award practices that achieve program outcomes.
3. Enhance public trust in HHS awards by mitigating fraud, waste, abuse, and mismanagement of grants and contracts.

Read the Strategic Plan

Resources*

Audits

The Office of Audit Services conducts independent audits of HHS programs and/or HHS grantees and contractors.  These audits examine the performance of HHS programs and/or grantees in carrying out their responsibilities and provide independent assessments of HHS programs and operations.  These reports also help reduce waste, abuse, and mismanagement and promote economy and efficiency throughout HHS.

• Maine Did Not Comply With Screening, Assessment, and Investigation Requirements for Responding to Reports of Child Abuse and Neglect
• California Used CARES Act Funds for Unallowable Nutrition Services Program Expenditures
• Heluna Health May Not Have Used California's CDC COVID-19 Funds in Accordance With Award Requirements
• ASPR Did Not Consistently Comply With Federal Requirements for Awarding Research and Development Contracts
• The National Institutes of Health Has Made Progress But Could Further Improve Its Closeout Process for Grants and Similar Awards
• NIH Did Not Close Contracts in Accordance With Federal Requirements, Resulting in the Increased Risk of Fraud, Waste, and Abuse
• Selected CDC Racial and Ethnic Approaches to Community Health Program Recipients Generally Complied With Federal Requirements But Did Not Meet All Targets and Charged Some Unallowable Costs
• New York Medical College Claimed Unallowable Grant Costs and Did Not Meet Certain Financial Conflict of Interest Requirements

Evaluations and Inspections

The Office of Evaluation and Inspections conducts national evaluations of HHS programs from a broad, issue-based perspective.  The evaluations focus on preventing fraud, waste or abuse in HHS programs and improving their efficiency and effectiveness.

• National Background Check Program for Long-Term Care Providers: A Final Assessment
• Most Children in Foster Care Did Not Receive Credit Checks and Assistance
• 2023 Performance Data for the Senior Medicare Patrol Projects
• Many States Lack Information To Monitor Maltreatment in Residential Facilities for Children in Foster Care
• Plans and Enrollment Often Fell Short for Underrepresented Groups in a Sample of NIH-Funded Clinical Trials
• Issue Brief: Insights from OIG's Work on the Office of Refugee Resettlement's Efforts to Care for Unaccompanied Children
• Gaps in Sponsor Screening and Followup Raise Safety Concerns for Unaccompanied Children
• NIH Did Not Consistently Meet Federal Single Audit Requirements for Extramural Grants

Recommendations

To drive positive change, many OIG reports identify recommendations for improvement.  Find a report's recommendations and the status of their implementation on the Recommendations Tracker.

OIG works with Government partners to investigate allegations of fraud involving grants and contracts.

• Avantor, Inc. Agrees to Pay $5.325 Million to Resolve Allegations of False Claims for Overcharging Federal Agencies and Allegations of DEA Violations and Lack of Compliance as to Listed Chemicals
• Danbury Non-Profit Settles Allegations It Enrolled Children of Employees Who Falsely Claimed to be Homeless into its Head Start Programs
• Dr. Timothy Niewold Agreed to Pay $160,000 for Allegedly Violating the Civil Monetary Penalties Law by Making False Statements in HHS Grant Applications
• Averhealth to Pay Over $1.3 Million to Resolve False Claims Act Allegations Related to Drug Tests Used in Michigan's Children's Protective Services & Foster Care Programs
• CityMD Agrees to Pay Over $12M for Alleged False Claims to the COVID-19 Uninsured Program
• Government Contractor Settles Claims That It Billed for Personnel Who Lacked Required Security Clearances
• Cleveland Clinic to Pay Over $7 Million to Settle Allegations of Undisclosed Foreign Sources of Funding on NIH Grant Applications and Reports

Grant Fraud Webpage     Contract Fraud Webpage     Grant and Contractor Fraud Self-Disclosures

OIG annually identifies top management and performance challenges HHS faces as it strives to fulfill its mission.  View challenges regarding grants and contracts below.

• Financial Integrity
• Data and Technology Security

• Testimony on Insights From the HHS Inspector General on Oversight of Unaccompanied Minors, Grant Management, and CMS
• Protecting U.S. Biomedical Research: Efforts to Prevent Undue Foreign Influence
  

• Improving Health and Well-Being in American Indian and Alaska Native Communities Through Compliance
• Whistleblower Protection
• Self-Disclosure Information
• Single Audits
• Fraud Alert: Scammers Steal Money From the Public Through Fake HHS Websites and Social Media Schemes

*Many contracts awarded by the Centers for Medicare and Medicaid Services are related to managed care agreements.  This page does not list resources related to Medicare Advantage or Medicaid managed care.  Those resources (including reports, fraud enforcement updates, Congressional testimony, and speeches) can be found at the Managed Care featured topic page.