HHS's Suspension and Debarment Program Helped Safeguard Federal Funding, But Opportunities for Improvement Exist
WHY WE DID THIS STUDY
As the Department of Health and Human Services (HHS) is the largest Federal grant-making agency ($531 billion in 2019) and the fourth-largest Federal contracting agency ($39 billion in 2019), it is important for it to have a robust suspension and debarment program. (Suspensions are preliminary, immediate actions that exclude persons from receiving new funds. Debarments are final determinations that exclude persons from receiving new funds for a specified time.) If bad actors or poor performers are not prevented from receiving additional Federal awards in a timely manner, beneficiaries of public health and human services programs may suffer and taxpayer funds may be misused.
HOW WE DID THIS STUDY
We analyzed multiple data sources to describe the outcomes, sources, and timeliness of suspension and debarment referrals during our review period, fiscal years 2015 through 2019. We also identified factors that may be affected the timeliness, efficiency, and effectiveness of HHS's suspension and debarment program. 
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Translation
For example, we reviewed referral data and surveyed awarding agencies and non-awarding entities. (Awarding agencies award HHS funds-e.g., grants and contracts. Non-awarding entities within HHS do not fund awards, but often have oversight responsibilities. Referrals for suspension or debarment are made by awarding agencies and non-awarding entities if they suspect awardee misconduct.) We also interviewed the Office of Recipient Integrity Coordination (ORIC), which receives referrals and manages the HHS suspension and debarment program, and HHS's suspension and debarment official (SDO), who determines if any suspension or debarment action should be implemented.
WHAT WE FOUND
Between FYs 2015 and 2019, 86 percent of referrals that HHS entities made to ORIC resulted in suspension, debarment, or other administrative action to protect Federal programs and funds. Nearly one-third of debarments involving grants had preceding suspensions. ORIC does not have complete guidance about the circumstances in which immediate action (i.e., suspension) may be appropriate while awaiting a debarment. Most of the referrals for suspension or debarment came from HHS non-awarding entities, while many HHS awarding agencies made no referrals during the 5 year period we reviewed. Suspension and debarment actions often missed ORIC's internal timeliness goals. Delays resulted in part from ongoing criminal or appeals proceedings and challenges in obtaining necessary information about the person referred for suspension or debarment. Other factors that affected the timeliness, efficiency, and effectiveness of this program were (1) vacancies and turnover at both the staff and senior leadership levels; (2) a limited system for case management and tracking of referrals; and (3) incomplete guidance regarding the use and documentation of corrective actions for fact-based referrals (as distinguished from conviction-based referrals).
WHAT WE RECOMMEND
To improve the timeliness, efficiency, and effectiveness of HHS's suspension and debarment program, we recommend that ASFR (1) take steps to ensure that the program has more consistent senior leadership and sufficient staffing; (2) improve the case management and tracking of referrals; (3) develop and disseminate guidance regarding how to prepare and submit complete referrals; and (4) conduct outreach and provide additional training to HHS awarding agencies that make few or no referrals. ASFR concurred with all four of our recommendations.