The Travis County Commissioners Court (TCCC) voted unanimously last Tuesday to conduct a more thorough third-party performance audit of Central Health (CH) after a previously planned audit was deemed to be too lax. A performance audit approved by the TCCC in late July—in response to a report raising concerns about the district’s performance—was criticized for its lack of public transparency, and Tuesday’s vote signifies TCCC’s intent to conduct a more in-depth review.
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CH—a health district designed to use taxpayer money to provide health care for low-income county residents in Travis County—was the subject of a Red Flags Report published in March by the NAACP and the League of United Latin American Citizens (LULAC) that alleges financial impropriety and failure to serve the community it was intended to.
In FY 2022, the report says CH raised its tax rate by 6% but diminished health care services by 34% from $155.1 million to $101.8 millions while raising its contingency reserves by 243% to $298.78 million.
“An in-depth performance audit is necessary to know the full amount of CH’s nonclinical expenses and whether they were spent efficiently and effectively,” reads the report. “As simply a healthcare payor, CH appears to have non-healthcare expenses that not only are much higher than presented but also much higher than appropriate. Despite repeated costly failures to establish an integrated healthcare delivery system, CH is planning major expenditures to develop yet another new service delivery plan.”
Unlike an annual financial audit—which only examines fiscal performance—a performance audit looks deeper, involving not only financial auditors but operational experts who understand health care and how it should be delivered to underserved communities.
CH’s first performance audit was conducted in 2018 and contained numerous recommendations to improve organizational performance, including a comprehensive study and analysis of gaps in the district that affect low-income populations of color in the county. In response to the concerns raised in the report, CH announced last month it was planning its second performance review to occur next year, with procurement for the auditing agency beginning later this year.
Critics said these reviews have been part of a public relations campaign by CH and that a more meaningful independent performance audit is needed to answer vital questions about its management and transparency. In response, TCCC held last week’s vote to implement a more independent review that will evaluate operational efficiency and effectiveness.
“What I’m hoping is that y’all will stand up for the taxpayers,” said retired Travis County Auditor Susan Spataro, advocating for a tougher audit ahead of TCCC’s vote. “We have the highest inflation in 40 years. People can’t pay rent or taxes. We must make sure that poor people are getting the best health care they can for the money.”