City audit finds contract-tracking gaps at Baltimore City Health Department, recommends tighter controls

Auditor Josh Pash presented a binding performance audit that found Baltimore City Health Department controls over professional and subrecipient contracting were insufficient to identify delays and increase legal and financial risk to the city.

The audit found the department’s contract tracker had a “design flaw,” with about 25% of expected date fields left blank and multiple incorrect date entries when compared with supporting documentation, and noted average approval times of roughly five months for subrecipient agreements when enough data was available. "The health department tracker is not effective to identify and address the contractual approval process delays," Auditor Josh Pash told the board.

The audit’s nut graf: the shortcomings impair the department’s ability to spot where approvals stall, have led to many contracts whose approval process began after the contract’s start date, and increase the risk of denied grant reimbursements and legal exposure. Pash said auditors selected random samples from fiscal 2022–23, traced contract and submission dates, and reviewed prior recommendations from the biannual report dated Dec. 20, 2022.

Key findings and evidence included: the number of subrecipient contracts rose from 35 in fiscal 2022 to 115 in 2023 and their combined value grew from about $23.7 million to roughly $27 million; of 420 date fields in the tracker about 103 (25%) were not entered; in tests of 120 dates auditors could trace 65 BOE submission dates but found many date mismatches for professional contracts. Auditors reported that, in the subset with enough data for analysis, average turnaround time for subrecipient contracts was roughly 159 days and the median about 130 days.

Auditors warned that in 27 of 33 analyzed contracts (about 82%) the approval process recorded in the tracker began after the contract’s stated start date. "Having services provided without a legally executed contract increases legal and financial risks to the city," Pash said, citing the possibility of denied grant reimbursements and delayed vendor payments.

Interim Baltimore City Health Department Commissioner Marybeth Haller and Chief Financial Officer Onyema Ekpa acknowledged the audit and described steps the department has already taken. "We agreed. That is true. But I do want to add some context because a lot of our contracts tracking is very manual — Excel spreadsheets," CFO Onyema Ekpa said, noting transitions during the audit period from COVID response, ARPA disbursements and retirements of experienced staff.

The health department told the board it has moved its tracker to Smartsheet, revised intake and budget templates, merged contract intake and compliance teams, hired a grant compliance analyst and manager, and plans an internal automation using Microsoft tools to reduce manual date entry. The agency said it is participating in a planned citywide contract lifecycle management system that will integrate with Workday; department staff said that system is citywide and will take more time to implement. Marybeth Haller said the department has begun reducing turnaround times and reported meeting a new internal goal of approving contracts within 90 days in the most recent period.

Board members pressed for clarity on governance and recovery of grant funds and noted the audit covers fiscal 2022–23, so later improvements may not be reflected. Comptroller Bill Henry and others emphasized that biennial audits show where the agency was during the audited period but may not capture later fixes.

The board noted the audit. The auditors recommended the health department formally define required tracker data points, record dates consistently, add automation to flag delays, monitor contract expirations so replacement work can be procured before start dates lapse and complete a risk-assessment and subrecipient monitoring schedule required by federal regulations. The health department committed to continuing the changes and said it aims to increase the share of contracts approved before the start date in fiscal 2026.